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General NPI Number Information
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NPI Number | 1346786175
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Entity Type | Organization
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Legal Business Name | FORTITUDE COUNSELING, LLC
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 771 E US HIGHWAY 80 SUITE 105
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City | FORNEY
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State | TX
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Zip | 75126-8699
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Country | US
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Telephone | 888-881-5107
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Fax | 888-550-6362
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Provider Business Mailing Address
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Address Line | 750 E US HIGHWAY 80 SUITE, 200-435
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City | FORNEY
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State | TX
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Zip | 75126-8722
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Country | US
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Telephone | 888-881-5107
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Fax | 888-550-6362
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ERICA WINN
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Credential | LPC, LMFT
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Telephone | 888-881-5107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64747
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License Number State | TX
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