Provider Demographics
NPI:1558610683
Name:FONTAINE, SONYA LEA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:LEA
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7441
Mailing Address - Country:US
Mailing Address - Phone:405-206-3185
Mailing Address - Fax:
Practice Address - Street 1:3500 S BOULEVARD
Practice Address - Street 2:BLDG B SUITE 12B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5486
Practice Address - Country:US
Practice Address - Phone:405-206-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional