Latisha Louise Fontana, M.ED. L.P.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CS001907 Issued in MO

Practice address

2646 Highway 109
Suite 200
Grover, MO 63040-1162

Phone

(636) 458-0002

Fax

(636) 458-0002

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

Yes

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

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902901770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 HIGHWAY 109",
            "address_2": "SUITE 200",
            "city": "GROVER",
            "state": "MO",
            "postal_code": "630401162",
            "telephone_number": "636-458-0002",
            "fax_number": "636-458-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2646 HIGHWAY 109",
            "address_2": "SUITE 200",
            "city": "GROVER",
            "state": "MO",
            "postal_code": "630401162",
            "telephone_number": "636-458-0002",
            "fax_number": "636-458-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANA",
        "first_name": "LATISHA",
        "middle_name": "LOUISE",
        "credential": "M.ED. L.P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "CS001907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Grover, MO
• Providers in Grover, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.