Active NPI
Tina M Fontenot, M.S.
- Psychologist
- League City, TX
National Provider Identifier
1720186869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 768
- Practice address
- 1301 Highway 96
League City, TX 77573-6313 - Phone
- (281) 724-9792
- NPI assigned
- Sep 20, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1182 | WV | |
| Psychologist | 103T00000X | 768 | WV | Primary |
| Professional Counselor | 101YP2500X | 66102 | TX |
Addresses
Primary practice location
1301 Highway 96
League City, TX 77573-6313
Mailing address
1301 Highway 96
League City, TX 77573-6313
Phone (281) 724-9792
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9205105000 | Medicaid | WV |
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66102 | TX | MD | Professional Counselor |
| 768 | WV | MD | Family Medicine Physician |
| 1182 | WV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285718400000",
"number": "1720186869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 HIGHWAY 96",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775736313",
"telephone_number": "281-724-9792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 HIGHWAY 96",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775736313",
"telephone_number": "281-724-9792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "TINA",
"middle_name": "M",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2010-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WV",
"license": "1182",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "768",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "66102",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9205105000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in League City, TX
- Andrew Flores, PTA
- Marissa Flores, PTA
- Melissa Vanessa Flores, FNP
- Rachel Flores, MS, RD, LD
- Erika Flynn, PHD
- Foot and Ankle Centers of Texas, PA
- For the Love of Words Speech and Language Therapy Services PLLC
- Kayla Nikole Foran, APRN
- Forefront Dermatology - Houston, PLLC
- Forefront Dermatology, S.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.