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NPI Code Detail

MEDICARE: TINA M FONTENOT M.S.

MEDICARE: TINA M FONTENOT M.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1182WV
2103T00000XPsychologist768WV
3101YP2500XProfessional Counselor66102TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720186869
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA M FONTENOT M.S.
Provider Business Mailing Address
First Line : 1301 HIGHWAY 96
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-6313
Country : US
Telephone Number : 281-724-9792
Fax Number :
Provider Business Practice Location Address
First Line : 1301 HIGHWAY 96
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-6313
Country : US
Telephone Number : 281-724-9792
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 09/29/2010

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