| Kelly Fountain, M.s., L.p.t., L.l.c. | |
|
2864 Dauphin St Suite A Mobile AL 36606-2479 | |
| (251) 470-7607 | |
| Not Available |
| Full Name | Kelly Fountain, M.s., L.p.t., L.l.c. |
|---|---|
| Speciality | Counselor |
| Location | 2864 Dauphin St, Mobile, Alabama |
| Authorized Official Name and Position | Kelly Fountain (OWNER) |
| Authorized Official Contact | 2514707607 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Fountain, M.s., L.p.t., L.l.c. 2864 Dauphin St Suite A Mobile AL 36606-2479 Ph: () - | Kelly Fountain, M.s., L.p.t., L.l.c. 2864 Dauphin St Suite A Mobile AL 36606-2479 Ph: (251) 470-7607 |
| NPI Number | 1154714384 |
|---|---|
| Provider Enumeration Date | 03/12/2015 |
| Last Update Date | 03/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154714384 | NPI | - | NPPES |
| 1003148487 | Other | AL | NPI |
| 511-33704 | Other | AL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 1586 (Alabama) | Primary |
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