1982589495 NPI number — TIFFANIE FONTAINE SCHOOL PSYCH

Table of content: TIFFANIE FONTAINE SCHOOL PSYCH (NPI 1982589495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982589495 NPI number — TIFFANIE FONTAINE SCHOOL PSYCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FONTAINE
Provider First Name:
TIFFANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SCHOOL PSYCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESCHI
Provider Other First Name:
TIFFANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982589495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 182
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95006-0182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 182
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOULDER CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95006-0182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-247-0476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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