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Individual
MATT V FORTNER
Active
Individual
MATT V FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3959
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3959
AL LPC LICENSE
AL
Enumeration date
01/16/2019
Last updated
01/16/2019
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