MEDICARE: FORTITUDINE HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1659190247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORTITUDINE HEALTH

Provider Business Mailing Address
First Line	:	3785 HARRISON BLVD STE 4
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-2072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3785 HARRISON BLVD
Second Line	:	STE 4
City	:	OGDEN
State	:	UT
Zip	:	84403
Country	:	US
Telephone Number	:	801-686-8488
Fax Number	:	951-269-4447

Authorized Official
Title or Position	:	MANAGER
Name	:	CLARISSA GOSNEY
Credential	:	PSYD
Telephone Number	:	619-800-3811

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	01/14/2026

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Directions to “FORTITUDINE HEALTH ” Practice Location

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