Provider Demographics
NPI:1831242460
Name:FORTIER, YVONNE T (MA, LPC, LISAC)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:T
Last Name:FORTIER
Suffix:
Gender:F
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N CENTRAL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1828
Mailing Address - Country:US
Mailing Address - Phone:602-424-2060
Mailing Address - Fax:602-424-1623
Practice Address - Street 1:4520 N CENTRAL AVE
Practice Address - Street 2:STE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1828
Practice Address - Country:US
Practice Address - Phone:602-424-2060
Practice Address - Fax:602-424-1623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10041101YA0400X
AZLPC-10495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional