Provider Demographics
NPI:1558128074
Name:LA FOUNTAINE, SARAH GAIL (LMSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GAIL
Last Name:LA FOUNTAINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21715 N ECLIPSE RD
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-1080
Mailing Address - Country:US
Mailing Address - Phone:208-625-7717
Mailing Address - Fax:
Practice Address - Street 1:21715 N ECLIPSE RD
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-1080
Practice Address - Country:US
Practice Address - Phone:208-625-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID44656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health