Provider Demographics
NPI:1477683373
Name:FONTENOT, AMY MARIE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E DYER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5600
Mailing Address - Country:US
Mailing Address - Phone:714-323-0471
Mailing Address - Fax:
Practice Address - Street 1:1221 E DYER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5600
Practice Address - Country:US
Practice Address - Phone:714-323-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health