Fortitude Therapy Collective | |
11549 Los Osos Valley Rd Ste 103 San Luis Obispo CA 93405-6457 | |
(805) 235-7792 | |
Not Available |
Full Name | Fortitude Therapy Collective |
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Speciality | Marriage & Family Therapist |
Location | 11549 Los Osos Valley Rd Ste 103, San Luis Obispo, California |
Authorized Official Name and Position | Gino Anthony Memoli (CEO) |
Authorized Official Contact | 8052357792 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Fortitude Therapy Collective 305 Leeward Ave Pismo Beach CA 93449-2121 Ph: (805) 235-7792 | Fortitude Therapy Collective 11549 Los Osos Valley Rd Ste 103 San Luis Obispo CA 93405-6457 Ph: (805) 235-7792 |
NPI Number | 1730947441 |
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Provider Enumeration Date | 03/07/2024 |
Last Update Date | 05/14/2024 |
Certification Date | 05/14/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730947441 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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