Fontenot, Tina M

Fontenot, Tina M is an sole proprietor health care provider with primary practice located at 1301 Highway 96 , League City TX 77573-6313. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Fontenot, Tina M can be contacted via phone (281) 724-9792.

Contact Information

Primary practice address
1301 Highway 96 League City TX 77573-6313
Phone: (281) 724-9792
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 1182 West Virginia
Behavioral Health & Social Service Providers / Psychologist 103T00000X 768 West Virginia
Behavioral Health & Social Service Providers / Professional 101YP2500X 66102 Texas

Profile Details

NPI number 1720186869
LBN Legal business name Fontenot, Tina M
Credentials M.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2006
Last updated Sep 29th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720186869 NPPES
West Virginia MEDICAID 9205105000

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