Provider Demographics
NPI:1386985703
Name:FONTENOT, TAMERA LORRAINE (LMHC)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:LORRAINE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13943
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-3943
Mailing Address - Country:US
Mailing Address - Phone:727-543-7556
Mailing Address - Fax:
Practice Address - Street 1:926 16TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1211
Practice Address - Country:US
Practice Address - Phone:727-543-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health