Healthcare Provider Details

I. General information

NPI: 1922902014
Provider Name (Legal Business Name): HAYLEE NICHOLE FONTAINE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 150
RIVERSIDE CA
92506-4286
US

IV. Provider business mailing address

6800 INDIANA AVE STE 150
RIVERSIDE CA
92506-4286
US

V. Phone/Fax

Practice location:
  • Phone: 951-227-3735
  • Fax:
Mailing address:
  • Phone: 951-227-3735
  • Fax: 951-684-6684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: