David W Fortel, LPC
Individual provider Active NPI Counselor · Fayette, MO
NPI 1477552842 · NPPES record last updated Jul 13, 2007
Key facts
- NPI
- 1477552842
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 001328 (MO)
- Practice address
- 600 W Morrison St
Fayette, MO 65248-1075 - Phone
- (660) 248-3313
- Fax
- (600) 248-3313
- NPI assigned
- Jul 19, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001328 | MO | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 001328 | MO | Yes |
Addresses
Primary practice location
600 W Morrison St
Fayette, MO 65248-1075
Mailing address
117 N Garth Ave
Columbia, MO 65203-4103
Phone (573) 443-2204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 326443 | Other | MO | HEALTHLINK |
| 22241 | Other | MO | BCBS |
| 22241 | Other | MO | ANTHEM EAP |
Other providers in Fayette, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.