MEDICARE: BUILDING A STRONGER FAMILY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396490256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING A STRONGER FAMILY

Provider Business Mailing Address
First Line	:	921 E DUPONT RD # 909
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1551
Country	:	US
Telephone Number	:	260-797-5892
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E RUDISILL BLVD STE B102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1756
Country	:	US
Telephone Number	:	260-797-5892
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	MR. JONATHON NEAL WATTLEY
Credential	:
Telephone Number	:	260-797-5892

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	03/01/2022

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Directions to “BUILDING A STRONGER FAMILY ” Practice Location

Language	Start Address	Practice Location

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