Active NPI
Shanna Kristine Fontaine
- Mental Health Counselor
- Denton, TX
National Provider Identifier
1609628478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 94163
- Practice address
- 1513 Willowwood St
Denton, TX 76205-6949 - Phone
- (940) 252-3595
- NPI assigned
- Apr 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 65374 | TX | |
| Mental Health Counselor | 101YM0800X | 94163 | TX | Primary |
Addresses
Primary practice location
1513 Willowwood St
Denton, TX 76205-6949
Mailing address
1513 Willowwood St
Denton, TX 76205-6949
Phone (940) 252-3595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94163 | TX | MD | Mental Health Counselor |
| 65374 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712102400000",
"number": "1609628478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1513 WILLOWWOOD ST",
"city": "DENTON",
"state": "TX",
"postal_code": "762056949",
"telephone_number": "940-252-3595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 WILLOWWOOD ST",
"city": "DENTON",
"state": "TX",
"postal_code": "762056949",
"telephone_number": "940-252-3595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTAINE",
"first_name": "SHANNA",
"middle_name": "KRISTINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-03",
"last_updated": "2024-04-03",
"certification_date": "2024-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "TX",
"license": "65374",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "94163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.