Individual
MRS. LAVONNA JUNE FORTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
6103 W AMARILLO BLVD STE A, AMARILLO, TX 79106-1936
(806) 355-1559
(806) 355-2273
Mailing address
6103 W AMARILLO BLVD STE A, AMARILLO, TX 79106-1936
(806) 355-1559
(806) 355-2273
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31581
TX
Other
Enumeration date
06/30/2006
Last updated
07/08/2007
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