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General NPI Number Information
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NPI Number | 1174397012
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Entity Type | Organization
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Legal Business Name | FORTITUDE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 124 W 46TH ST STE 110
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City | KEARNEY
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State | NE
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Zip | 68847-8348
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Country | US
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Telephone | 308-440-9042
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Fax |
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Provider Business Mailing Address
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Address Line | 124 W 46TH ST STE 110
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City | KEARNEY
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State | NE
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Zip | 68847-8348
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Country | US
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Telephone | 308-440-9042
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | LYNN DANIELLE COOPER
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Credential | MS LIMHP LPC
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Telephone | 308-440-9042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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