Individual
MICHAEL FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 BEAUMONT AVE # 1, LIBERTY, TX 77575-5126
(936) 253-1077
Mailing address
2800 BEAUMONT AVE # 1, LIBERTY, TX 77575-5126
(936) 253-1077
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12037
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12037
LICENSE
TX
Enumeration date
10/28/2015
Last updated
10/28/2015
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