Provider Demographics
NPI:1629575253
Name:FORTIS THERAPY LLC
Entity Type:Organization
Organization Name:FORTIS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-675-1275
Mailing Address - Street 1:1949 SUGARLAND DR STE 221
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5766
Mailing Address - Country:US
Mailing Address - Phone:307-675-1275
Mailing Address - Fax:307-675-1276
Practice Address - Street 1:1949 SUGARLAND DR STE 221
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5766
Practice Address - Country:US
Practice Address - Phone:307-675-1275
Practice Address - Fax:307-675-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130795900Medicaid