Individual
MS. NICOLE AMALIE FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1267
Mailing address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1267
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/10/2017
Last updated
11/24/2021
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