Healthcare Provider Details

I. General information

NPI: 1659190247
Provider Name (Legal Business Name): FORTITUDINE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3785 HARRISON BLVD STE 4
OGDEN UT
84403-2072
US

IV. Provider business mailing address

3785 HARRISON BLVD STE 4
OGDEN UT
84403-2072
US

V. Phone/Fax

Practice location:
  • Phone: 801-791-4975
  • Fax: 385-541-2753
Mailing address:
  • Phone: 801-791-4975
  • Fax: 385-541-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLARISSA J GOSNEY
Title or Position: PRESIDENT
Credential: PSYD
Phone: 619-800-3811