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General NPI Number Information
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NPI Number | 1134940463
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Entity Type | Organization
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Legal Business Name | FORTIVA THERAPY
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Dates
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Enumeration Date | 10/19/2024
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2615 PACIFIC COAST HWY STE 225
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2228
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Country | US
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Telephone | 310-906-0895
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Fax |
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Provider Business Mailing Address
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Address Line | 2615 PACIFIC COAST HWY STE 225
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2228
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Country | US
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Telephone | 310-906-0895
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KELLY HAYES
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Credential | LMFT, LPCC
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Telephone | 310-906-0895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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