Provider Demographics
NPI:1972000131
Name:FONTENOT, TANYA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:J
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 AUBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0364
Mailing Address - Country:US
Mailing Address - Phone:916-350-1768
Mailing Address - Fax:
Practice Address - Street 1:2580 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1455
Practice Address - Country:US
Practice Address - Phone:530-722-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical