Provider Demographics
NPI:1306462734
Name:FONTENELLE, PAULA BORGES
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:BORGES
Last Name:FONTENELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 NE BAKER ST STE 280
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4958
Mailing Address - Country:US
Mailing Address - Phone:503-435-4840
Mailing Address - Fax:
Practice Address - Street 1:609 NE BAKER ST STE 280
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4958
Practice Address - Country:US
Practice Address - Phone:503-435-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health