MEDICARE: FORTITUDE WELLNESS AND CONSULTATIONS

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821928383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDE WELLNESS AND CONSULTATIONS

Provider Business Mailing Address
First Line	:	12401 ROCKSIDE RD UNIT 25611
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-7331
Country	:	US
Telephone Number	:	216-303-4196
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 ROCKSIDE RD UNIT 25611
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-7331
Country	:	US
Telephone Number	:	216-303-4196
Fax Number	:

Authorized Official
Title or Position	:	CEO/CLINICAL DIRECTOR
Name	:	BRYANTA L SPENCER
Credential	:	LISW-S
Telephone Number	:	216-303-4196

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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