Krystal Marie Fountaine

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-16-23131 Issued in CA

Practice address

5554 Reseda Blvd Ste 203
Tarzana, CA 91356-6212

Phone

(818) 698-9507

NPI assigned

May 1, 2009

Last updated

Jan 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• Learning and Behavioral Center,LLC

  • Behavior Analyst
  • Tarzana, CA
  • NPI 1619258712
  NPD
• Learning and Behavioral Center. LLC

  • Behavior Analyst
  • Tarzana, CA
  • NPI 1710116223
  NPD

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

{
    "created_epoch": "1241136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1811131014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5554 RESEDA BLVD STE 203",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913566212",
            "telephone_number": "818-698-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5554 RESEDA BLVD STE 203",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913566212",
            "telephone_number": "818-698-9507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6004 Walden Dr",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379196370",
            "country_code": "US",
            "telephone_number": "818-698-9507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOUNTAINE",
        "first_name": "KRYSTAL",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-01",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-16-23131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Marie Forsyth, MSN, NP-C
• Fortiva Pharmacy Inc
• Fortiva Pharmacy Inc
• Foundation Hand Surgery Institute a Professional Corporation
• Foundation Medical Institute, a Professional Corporation
• Alan Fozailoff, M.D.
• Maria Angelica Fraire-Morales, MSW
• Monica Franco
• Frank Laaly DDS Inc (Amalia Dental Group)
• Jennifer Frank, PH.D.

• Behavior Analyst in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.