Healthcare Provider Details

I. General information

NPI: 1174397012
Provider Name (Legal Business Name): FORTITUDE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W 46TH ST STE 110
KEARNEY NE
68847-8348
US

IV. Provider business mailing address

124 W 46TH ST STE 110
KEARNEY NE
68847-8348
US

V. Phone/Fax

Practice location:
  • Phone: 308-440-9042
  • Fax:
Mailing address:
  • Phone: 308-440-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNN DANIELLE COOPER
Title or Position: OWNER/THERAPIST
Credential: MS LIMHP LPC
Phone: 308-440-9042