Healthcare Provider Details

I. General information

NPI: 1841528361
Provider Name (Legal Business Name): RANDY FONTENOT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 PERKINS RD # 180B
BATON ROUGE LA
70808-9111
US

IV. Provider business mailing address

7520 PERKINS RD STE 180B
BATON ROUGE LA
70808-9111
US

V. Phone/Fax

Practice location:
  • Phone: 225-276-8428
  • Fax: 225-709-9422
Mailing address:
  • Phone: 225-276-8428
  • Fax: 225-709-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2810
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2810
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: