Healthcare Provider Details

I. General information

NPI: 1629127154
Provider Name (Legal Business Name): TRINITY WELLNESS ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10305 DAWSONS CREEK BLVD SUITE C
FORT WAYNE IN
46825-1914
US

IV. Provider business mailing address

10305 DAWSONS CREEK BLVD SUITE C
FORT WAYNE IN
46825-1914
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-4493
  • Fax: 260-416-0601
Mailing address:
  • Phone: 260-483-4493
  • Fax: 260-416-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN A. OTT
Title or Position: PSYCHOLOGIST
Credential: PH.D., HSPP
Phone: 260-483-4493