MEDICARE: FORTITUDE ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508629452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDE ABA LLC

Provider Business Mailing Address
First Line	:	1422 MARRIMANS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8576
Country	:	US
Telephone Number	:	951-553-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 GOTHIC CT STE 108
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2812
Country	:	US
Telephone Number	:	951-553-0110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANK ANTHONY MELIA
Credential	:	BCBA
Telephone Number	:	951-553-0110

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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