Provider Demographics
NPI:1831869502
Name:FONTENOT, SHEILA A (MA, LPC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:A
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:4480 GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7202
Practice Address - Country:US
Practice Address - Phone:417-761-5492
Practice Address - Fax:417-336-1204
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10386101YP2500X
MO2022012915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490108477Medicaid