Provider Demographics
NPI:1124054887
Name:FOUNTAIN, BRUCE ALMON (MS, LMFT, RAS)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALMON
Last Name:FOUNTAIN
Suffix:
Gender:M
Credentials:MS, LMFT, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-792-9797
Mailing Address - Fax:909-792-8097
Practice Address - Street 1:101 E REDLANDS BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4775
Practice Address - Country:US
Practice Address - Phone:909-792-9797
Practice Address - Fax:909-792-8097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist