Individual
TARA FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
302 DULLES DR, LAFAYETTE, LA 70506-3008
(337) 262-4100
(337) 262-1146
Mailing address
302 DULLES DR, LAFAYETTE, LA 70506-3008
(337) 262-4100
(337) 262-1146
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11438
LA
Other
Enumeration date
12/06/2012
Last updated
12/16/2020
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