Provider Demographics
NPI:1477999498
Name:FORTINO, JULIET (MC, LPC, RPT-S)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:FORTINO
Suffix:
Gender:F
Credentials:MC, LPC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89364
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-9364
Mailing Address - Country:US
Mailing Address - Phone:520-240-8488
Mailing Address - Fax:
Practice Address - Street 1:3801 N CAMPBELL AVE STE A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1448
Practice Address - Country:US
Practice Address - Phone:520-240-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10235101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health