Dr. John E Fontaine IV
Clinical Child & Adolescent Psychologist
1855 Crane Ridge Dr Ste A
Jackson
, Mississippi 39216-4944
Dr. John E Fontaine IV
Clinical Child & Adolescent Psychologist
1855 Crane Ridge Dr Ste A
Jackson
, Mississippi 39216-4944
(601) 366-3906
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About
Features
Specialties
- Clinical Child & Adolescent Psychologist
Languages spoken
- English
Location
First Address
- Dr. John E Fontaine IV
- 1855 Crane Ridge Dr Ste A
- Jackson, MS
- Zip : 39216-4944
- Fax : (601) 366-3906
- Phone : (601) 982-8700
Second Address
- Dr. John E Fontaine IV
- 1855 Crane Ridge Dr Ste A
- Jackson, MS
- Zip : 39216-4944
- Fax : (601) 366-3906
- Phone : (601) 982-8700
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 30429 | MS |
National Provider Identifier
| NPI | 1093818064 |
|---|---|
| Provider Name | Dr. John E Fontaine IV |
| First Address | Jackson, MS 39216-4944 |
| Second Address | Jackson, MS 39216-4944 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/09/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00011417 | (05) | MS |
| S01466 | (02) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.