Individual
MARIE GENEVIEVE FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22476 E CREOSOTE DR, QUEEN CREEK, AZ 85142-8528
(949) 690-1953
Mailing address
22476 E CREOSOTE DR, QUEEN CREEK, AZ 85142-8528
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CP0154
NV
101YM0800X
Mental Health Counselor
Primary
—
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2013
Last updated
04/10/2026
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