Individual
MARTICE FONTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2271 OVERLAND AVE STE 5, BURLEY, ID 83318-2957
(208) 678-9114
(208) 678-8989
Mailing address
2271 OVERLAND AVE STE 5, BURLEY, ID 83318-2957
(208) 678-9114
(208) 678-8989
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LAMFT-5182
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376561274
—
ID
Enumeration date
04/15/2014
Last updated
04/15/2014
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