Provider Demographics
NPI:1689200073
Name:GUILLOT, DENISE LYNN
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:GUILLOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:CHENEYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71325-0407
Mailing Address - Country:US
Mailing Address - Phone:318-279-2751
Mailing Address - Fax:
Practice Address - Street 1:10627 HWY 71
Practice Address - Street 2:
Practice Address - City:CHENEYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71325-1325
Practice Address - Country:US
Practice Address - Phone:318-279-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA544101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)