| Fortitude Trails Counseling | |
|
4460 N Illinois St Ste 1 Swansea IL 62226-1899 | |
| (618) 277-7570 | |
| Not Available |
| Full Name | Fortitude Trails Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 4460 N Illinois St Ste 1, Swansea, Illinois |
| Authorized Official Name and Position | Lisa M Fox (OWNER) |
| Authorized Official Contact | 6189201680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fortitude Trails Counseling 2921 Maryville Rd Ste B Maryville IL 62062-5400 Ph: (618) 484-9337 | Fortitude Trails Counseling 4460 N Illinois St Ste 1 Swansea IL 62226-1899 Ph: (618) 277-7570 |
| NPI Number | 1295327575 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 11/28/2023 |
| Certification Date | 11/28/2023 |
| Medicare PECOS PAC ID | 8921414947 |
|---|---|
| Medicare Enrollment ID | O20210316003030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295327575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa M Saunders |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184244261 PECOS PAC ID: 8022449032 Enrollment ID: I20200507000246 |
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