Individual
REBECCA FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPA
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-9767
Mailing address
1640 JEFFERSON ST APT 203, PADUCAH, KY 42001-2721
(270) 559-9547
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
174287
KY
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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