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General NPI Number Information
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NPI Number | 1457031965
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Entity Type | Organization
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Legal Business Name | FORTIFY FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 720 WASHINGTON ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1401
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Country | US
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Telephone | 208-220-4197
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Fax |
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Provider Business Mailing Address
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Address Line | 720 WASHINGTON ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID W. ROBERTS
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Credential | LCPC
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Telephone | 208-220-4197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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