MEDICARE: BUILDING BLOCKS COUNSELING,LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841761558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS COUNSELING,LLC

Provider Business Mailing Address
First Line	:	PO BOX 44701
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-4701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15255 N 40TH ST STE 135
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4682
Country	:	US
Telephone Number	:	602-626-8112
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	VERN JOHNSON
Credential	:
Telephone Number	:	602-626-8112

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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