Provider Demographics
NPI:1881077873
Name:COUVILLION, AERIN MAYLISE (LAC, ACA)
Entity type:Individual
Prefix:
First Name:AERIN
Middle Name:MAYLISE
Last Name:COUVILLION
Suffix:
Gender:F
Credentials:LAC, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PARK BLVD.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6630
Mailing Address - Country:US
Mailing Address - Phone:225-658-6624
Mailing Address - Fax:
Practice Address - Street 1:4710 MCHUGH RD.
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-658-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist