Healthcare Provider Details

I. General information

NPI: 1225858640
Provider Name (Legal Business Name): DAVID FONTANE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 02/03/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 VILLAGE CREEK DR STE 2002
PLANO TX
75093-4498
US

IV. Provider business mailing address

7500 SAN FELIPE ST STE 990
HOUSTON TX
77063-1708
US

V. Phone/Fax

Practice location:
  • Phone: 682-324-9376
  • Fax: 469-519-9103
Mailing address:
  • Phone: 281-826-3382
  • Fax: 425-491-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: