IndividualActive
John Fontaine, PH.D.
NPI 1093818064 · Clinical Child & Adolescent Psychologist · Jackson, MS
Provider details
- NPI number
- 1093818064
- Entity type
- Individual
- Primary specialty
- Clinical Child & Adolescent PsychologistBehavioral Health & Social Service Providers
- Credential
- PH.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 30429 (MS)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
1855 Crane Ridge Dr Ste a
Jackson, MS 39216-4944
Phone: (601) 982-8700
Fax: (601) 366-3906
Approximate (ZIP-level) locationGet directions
Mailing address
1855 Crane Ridge Dr Ste a
Jackson, MS 39216-4944
Registry dates
- Enumerated
- 2006-09-06
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.