Healthcare Provider Details

I. General information

NPI: 1841962305
Provider Name (Legal Business Name): FORTITUDE COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S STATE ST STE 245
CLEARFIELD UT
84015-1001
US

IV. Provider business mailing address

189 S STATE ST STE 245
CLEARFIELD UT
84015-1001
US

V. Phone/Fax

Practice location:
  • Phone: 801-877-2288
  • Fax:
Mailing address:
  • Phone: 801-877-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMIE DIARTE
Title or Position: OWNER
Credential:
Phone: 801-877-2288