Provider Demographics
NPI:1497197958
Name:LAFONTE, JON (BA PSY)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:LAFONTE
Suffix:
Gender:M
Credentials:BA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 ANTHRACITE
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2390
Mailing Address - Country:US
Mailing Address - Phone:970-858-3378
Mailing Address - Fax:
Practice Address - Street 1:791 ANTHRACITE
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2390
Practice Address - Country:US
Practice Address - Phone:970-858-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10101Y00000X
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor