Provider Demographics
NPI:1164948063
Name:FONNEGRA, LOUANNA BERNICE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LOUANNA
Middle Name:BERNICE
Last Name:FONNEGRA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29960 SAGUARO ST
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3578
Mailing Address - Country:US
Mailing Address - Phone:818-288-8744
Mailing Address - Fax:
Practice Address - Street 1:29960 SAGUARO ST
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3578
Practice Address - Country:US
Practice Address - Phone:818-288-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87341106H00000X
CA112865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist