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General NPI Number Information
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NPI Number | 1487419875
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Entity Type | Organization
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Legal Business Name | FORTITUDE COUNSELING AND TREATMENT LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 12/15/2024
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Provider Practice Location Address
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Address Line | 912 12TH AVE S STE 208
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City | NAMPA
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State | ID
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Zip | 83651-4681
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Country | US
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Telephone | 208-953-1302
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Fax |
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Provider Business Mailing Address
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Address Line | 11108 ALAMO LN
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City | NAMPA
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State | ID
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Zip | 83686-9244
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Country | US
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Telephone | 208-953-1302
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Fax |
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Authorized Official
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Title or Position | OWNER/LCPC
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Name | HILARY JOAN RAPTOSH
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Credential | LCPC
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Telephone | 208-953-1302
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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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