Provider Demographics
NPI:1306023932
Name:FOUNTAIN, ERIKA KARNA (MA LPC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:KARNA
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-2000
Mailing Address - Country:US
Mailing Address - Phone:262-248-7942
Mailing Address - Fax:262-248-1202
Practice Address - Street 1:101 BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-2000
Practice Address - Country:US
Practice Address - Phone:262-248-7942
Practice Address - Fax:262-248-1202
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4002-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43732300Medicaid