Provider Demographics
NPI:1619664703
Name:FANT, PARIS (LPC-A)
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:FANT
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8164 CARDINAL LN UNIT D
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1868
Mailing Address - Country:US
Mailing Address - Phone:404-424-2476
Mailing Address - Fax:
Practice Address - Street 1:507 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-4867
Practice Address - Country:US
Practice Address - Phone:512-850-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional