Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | T0209 | OR |
NPI | 1003071721 |
---|---|
Provider Name | Lynn A Fontana |
First Address | Portland, OR 97218-4249 |
Second Address | Portland, OR 97218-4249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 22/07/2008 |