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NPI Code Detail

MEDICARE: MR. RICHARD FONTENOT M.A., M.F.T.

MEDICARE: MR. RICHARD FONTENOT M.A., M.F.T.
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
1101YM0800XMental Health Counselor48187CA

General Provider Information

NPI Number : 1952465312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD FONTENOT M.A., M.F.T.
Provider Business Mailing Address
First Line : 608 S ST ANDREWS PL
Second Line : PENTHOUSE 509
City : LOS ANGELES
State : CA
Zip : 90005-3098
Country : US
Telephone Number : 323-981-4301
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MCDONNELL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90040-5623
Country : US
Telephone Number : 323-981-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 06/11/2009

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