Provider Demographics
NPI:1548989825
Name:BOUTTE, SIERRA (LCSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:BOUTTE
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 1:2309 GRAND POINT RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-3323
Mailing Address - Country:US
Mailing Address - Phone:337-935-2310
Mailing Address - Fax:
Practice Address - Street 1:2309 GRAND POINT RD
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3323
Practice Address - Country:US
Practice Address - Phone:337-935-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA157351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical