Provider Demographics
NPI:1700341880
Name:MONROE, JEFF CULLEN (RAC-5049)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:CULLEN
Last Name:MONROE
Suffix:
Gender:M
Credentials:RAC-5049
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HIGHWAY 956
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:LA
Mailing Address - Zip Code:70730-4520
Mailing Address - Country:US
Mailing Address - Phone:225-683-4144
Mailing Address - Fax:
Practice Address - Street 1:10473 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8264
Practice Address - Country:US
Practice Address - Phone:225-924-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5049101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)