Healthcare Provider Details

I. General information

NPI: 1538015193
Provider Name (Legal Business Name): FORTITUDE MENTAL HEALTH GROUP PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 EL DORADO DR
HUNTINGTON BEACH CA
92649-4567
US

IV. Provider business mailing address

17011 BEACH BLVD STE 900 PMB 850
HUNTINGTON BEACH CA
92647-5998
US

V. Phone/Fax

Practice location:
  • Phone: 949-775-1785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE CHITTUM
Title or Position: CEO / NURSE PRACTITIONER
Credential: NP
Phone: 949-775-1785