Provider Demographics
NPI:1821608613
Name:FORTNEY, EMILY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:PSYD
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 509
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-0509
Mailing Address - Country:US
Mailing Address - Phone:404-895-6416
Mailing Address - Fax:
Practice Address - Street 1:5960 S LAND PARK DR # 1194
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3313
Practice Address - Country:US
Practice Address - Phone:404-895-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS581024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical