Provider Demographics
NPI:1841962305
Name:FORTITUDE COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:FORTITUDE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-877-2288
Mailing Address - Street 1:189 S STATE ST STE 245
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1001
Mailing Address - Country:US
Mailing Address - Phone:801-877-2288
Mailing Address - Fax:
Practice Address - Street 1:189 S STATE ST STE 245
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1001
Practice Address - Country:US
Practice Address - Phone:801-877-2288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty