Provider Demographics
NPI:1386416501
Name:FONTENOT, LESLIE DUGAS (MA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DUGAS
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ENERGY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3816
Mailing Address - Country:US
Mailing Address - Phone:337-261-8781
Mailing Address - Fax:
Practice Address - Street 1:101 SOARING CV
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5851
Practice Address - Country:US
Practice Address - Phone:337-849-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health