Provider Demographics
NPI:1427343979
Name:FOUNTAIN-ROBERTSON, KATHY (LMHC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:FOUNTAIN-ROBERTSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:FOUNTAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:238 E DAVIS BLVD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3792
Mailing Address - Country:US
Mailing Address - Phone:813-833-8393
Mailing Address - Fax:813-258-3800
Practice Address - Street 1:238 E DAVIS BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3792
Practice Address - Country:US
Practice Address - Phone:813-833-8393
Practice Address - Fax:813-258-3800
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health