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General NPI Number Information
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NPI Number | 1730947441
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Entity Type | Organization
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Legal Business Name | FORTITUDE MARRIAGE AND FAMILY THERAPY INCORPORATED
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 11549 LOS OSOS VALLEY RD STE 103
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-6457
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Country | US
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Telephone | 805-235-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 11549 LOS OSOS VALLEY RD STE 103
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-6457
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Country | US
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Telephone | 805-235-7792
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GINO ANTHONY MEMOLI III
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Credential |
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Telephone | 805-235-7792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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