Provider Demographics
NPI:1063887131
Name:FONTENOT, JESSICA (LPC, LRC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:LPC, LRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S COLLEGE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 S COLLEGE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3212
Practice Address - Country:US
Practice Address - Phone:337-456-7880
Practice Address - Fax:337-456-7882
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA730101YP2500X
LA4651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health