Provider Demographics
NPI:1265976930
Name:RANDY FONTENOT COUNSELING & CONSULTING SERVICES
Entity type:Organization
Organization Name:RANDY FONTENOT COUNSELING & CONSULTING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:225-276-8428
Mailing Address - Street 1:5329 DIJON DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4378
Mailing Address - Country:US
Mailing Address - Phone:225-276-8428
Mailing Address - Fax:
Practice Address - Street 1:5329 DIJON DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4378
Practice Address - Country:US
Practice Address - Phone:225-276-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDY FONTENOT COUNSELING & CONSULTING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1178106H00000X
LA2810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty