| Fortitude 611 Llc | |
|
25062 S 190th St Queen Creek AZ 85142-5668 | |
| (480) 329-0707 | |
| Not Available |
| Full Name | Fortitude 611 Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 25062 S 190th St, Queen Creek, Arizona |
| Authorized Official Name and Position | Jaime Ingram (OWNER) |
| Authorized Official Contact | 4803290707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortitude 611 Llc 25062 S 190th St Queen Creek AZ 85142-5668 Ph: (480) 329-0707 | Fortitude 611 Llc 25062 S 190th St Queen Creek AZ 85142-5668 Ph: (480) 329-0707 |
| NPI Number | 1003504390 |
|---|---|
| Provider Enumeration Date | 04/25/2023 |
| Last Update Date | 04/26/2023 |
| Certification Date | 04/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003504390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
Positiveaba Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 18521 E Queen Creek Rd, Sute 105-627, Queen Creek, AZ 85142 Phone: 480-361-1025 | |
Combs Therapy And Counseling Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 21453 E Misty Ln, Queen Creek, AZ 85142 Phone: 480-875-2767 | |
Troutman Counseling Services, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 21321 E Ocotillo Rd Ste 113, Queen Creek, AZ 85142 Phone: 480-465-9841 | |
Queen Creek Counseling Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 21321 E Ocotillo Rd, B-105, Queen Creek, AZ 85142 Phone: 480-258-2915 Fax: 480-888-0231 | |
Lotus Holistic Healthcare Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 22424 S Ellsworth Loop Rd, Queen Creek, AZ 85142 Phone: 602-492-7632 | |
East Valley Family Therapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 21321 E Ocotillo Rd Ste 132, Queen Creek, AZ 85142 Phone: 602-759-0512 Fax: 602-584-7290 |