Provider Demographics
NPI:1831691542
Name:MOUTON, RACHEL E
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:E
Last Name:MOUTON
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 1:302 COUNTRY LAKES TRL
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-2662
Mailing Address - Country:US
Mailing Address - Phone:337-501-2647
Mailing Address - Fax:
Practice Address - Street 1:302 COUNTRY LAKES TRL
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-2662
Practice Address - Country:US
Practice Address - Phone:337-501-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOS575810251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)