Provider Demographics
NPI:1730947441
Name:FORTITUDE MARRIAGE AND FAMILY THERAPY INCORPORATED
Entity type:Organization
Organization Name:FORTITUDE MARRIAGE AND FAMILY THERAPY INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GINO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MEMOLI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:805-235-7792
Mailing Address - Street 1:305 LEEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2121
Mailing Address - Country:US
Mailing Address - Phone:805-235-7792
Mailing Address - Fax:
Practice Address - Street 1:11549 LOS OSOS VALLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-6457
Practice Address - Country:US
Practice Address - Phone:805-235-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORTITUDE MARRIAGE AND FAMILY THERAPY INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-07
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty