Healthcare Provider Details

I. General information

NPI: 1750247979
Provider Name (Legal Business Name): FORTITUDE THERAPEUTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 OSUNA RD NE STE 209
ALBUQUERQUE NM
87107-5950
US

IV. Provider business mailing address

4300 CANDLESTICK DR NE
ALBUQUERQUE NM
87109-2901
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-2619
  • Fax:
Mailing address:
  • Phone: 505-573-2619
  • 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: LESLIE LUCERO
Title or Position: OWNER
Credential: LPCC
Phone: 505-573-2619