NPIMap

Organization Active NPI

Fortitude Trails Counseling

  • Clinical Social Worker
  • Swansea, IL
National Provider Identifier
1295327575
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
FORTITUDE TRAILS COUNSELING
Practice address
4460 N Illinois St Ste 1
Swansea, IL 62226-1899
Phone
(618) 277-7570
NPI assigned
Feb 8, 2021
Last updated
Nov 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa M Fox, LCSWNPI 1184244261
Title
Owner
Phone
(618) 920-1680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

4460 N Illinois St Ste 1
Swansea, IL 62226-1899

Mailing address

2921 Maryville Rd Ste B
Maryville, IL 62062-5400
Phone (618) 484-9337

Other practice location 1

2921 Maryville Rd Ste B
Maryville, IL 62062-5400
Phone (618) 484-9337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210316003030 IL Part B Supplier - Clinic/Group Practice 8921414947 Receives reassigned benefits from 3 practitioners
Practice locations: Maryville, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1295327575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 MARYVILLE RD STE B",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625400",
            "telephone_number": "618-484-9337",
            "fax_number": "618-484-9353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4460 N ILLINOIS ST STE 1",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622261899",
            "telephone_number": "618-277-7570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2921 Maryville Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620625400",
            "country_code": "US",
            "telephone_number": "618-484-9337",
            "fax_number": "618-484-9353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FORTITUDE TRAILS COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-08",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-920-1680",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansea, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.