Healthcare Provider Details

I. General information

NPI: 1023977501
Provider Name (Legal Business Name): TAWNY FORTITUDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 NE SPRING CREEK PL
LEES SUMMIT MO
64086-7089
US

IV. Provider business mailing address

508 NE SPRING CREEK PL
LEES SUMMIT MO
64086-7089
US

V. Phone/Fax

Practice location:
  • Phone: 816-944-0004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: