Laura Fontaine, MS, EDS, LISAC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-15936 Issued in AZ

Practice address

2345 S Alma School Rd Ste 105
Mesa, AZ 85210-4013

Phone

(480) 206-4753

NPI assigned

Dec 7, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 9, 2024 through May 9, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vivify Wellness LLC

  • Addiction (Substance Use Disorder) Counselor
  • Mesa, AZ
  • NPI 1366807596

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1457726036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18445 E PINE VALLEY DR",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851423622",
            "telephone_number": "480-206-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 S ALMA SCHOOL RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104013",
            "telephone_number": "480-206-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTAINE",
        "first_name": "LAURA",
        "credential": "MS, EDS, LISAC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-07",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-15936",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC-10622",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenenah A Foller, RPH
• Shanna Folley, LMT
• Yury Fomin, MD
• Alice Fong, SLPA
• Carrie E Fontaine, P.A.
• Foothills Psychiatric Services PLLC
• Foothills Sports Medicine & Physical Therapy - North Mesa LLC
• Foothills Sports Medicine & Physical Therapy - Red Mountain LLC
• Foothills Sports Medicine & Rehabilitation - East Valley Inc
• Foothills Sports Medicine & Rehabilitation, LLC

• Professional Counselor in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.