Provider Demographics
NPI:1295454361
Name:COUVILLION, TARYN FONTENOT (LCSW)
Entity type:Individual
Prefix:MS
First Name:TARYN
Middle Name:FONTENOT
Last Name:COUVILLION
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 STANFORD AVE APT 1428
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3640
Mailing Address - Country:US
Mailing Address - Phone:225-936-0035
Mailing Address - Fax:
Practice Address - Street 1:900 STANFORD AVE APT 1428
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3640
Practice Address - Country:US
Practice Address - Phone:225-936-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical