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NPI Code Detail

MEDICARE: MISS GWYNETH FORTNEY

MEDICARE: MISS GWYNETH FORTNEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528742632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS GWYNETH FORTNEY
Provider Business Mailing Address
First Line : 434 FOUNTAIN VW
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-3848
Country : US
Telephone Number : 304-680-5683
Fax Number :
Provider Business Practice Location Address
First Line : 425 INDUSTRIAL AVE STE 201
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-2287
Country : US
Telephone Number : 304-241-1854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2023
Last Update Date : 06/12/2023

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Directions to “ MISS GWYNETH FORTNEY ” Practice Location

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