Healthcare Provider Details

I. General information

NPI: 1801204219
Provider Name (Legal Business Name): CHARLETTE A FORTEZA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PASEO DEL PINON
SANTA FE NM
87508-9371
US

IV. Provider business mailing address

37 PASEO DEL PINON
SANTA FE NM
87508-9371
US

V. Phone/Fax

Practice location:
  • Phone: 720-278-9928
  • Fax:
Mailing address:
  • Phone: 720-278-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131924
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: