Provider Demographics
NPI:1578796652
Name:FONTENOT, LATAUNYA M (LPC)
Entity Type:Individual
Prefix:
First Name:LATAUNYA
Middle Name:M
Last Name:FONTENOT
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 1:13502 TRAIL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2169
Mailing Address - Country:US
Mailing Address - Phone:281-431-9228
Mailing Address - Fax:
Practice Address - Street 1:13502 TRAIL MEADOW LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2169
Practice Address - Country:US
Practice Address - Phone:281-431-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18311101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool