Provider Demographics
NPI:1194459453
Name:FONTAINE, KELSI (LPC, NCC)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 BLOOMING GLEN RD.
Mailing Address - Street 2:P.O. BOX 43
Mailing Address - City:BLOOMING GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:18911-3414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 BLOOMING GLEN RD.
Practice Address - Street 2:P.O. BOX 43
Practice Address - City:BLOOMING GLEN
Practice Address - State:PA
Practice Address - Zip Code:18911-3414
Practice Address - Country:US
Practice Address - Phone:267-343-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional