Healthcare Provider Details

I. General information

NPI: 1669364048
Provider Name (Legal Business Name): CM HEART2SOUL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 S CALHOUN ST STE 102
FORT WAYNE IN
46807-1305
US

IV. Provider business mailing address

1118 E BELMONT DR
FORT WAYNE IN
46806-5181
US

V. Phone/Fax

Practice location:
  • Phone: 260-804-9563
  • Fax:
Mailing address:
  • Phone: 260-804-9563
  • Fax:

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 Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMARA D. FILES
Title or Position: REGISTERED NURSE/MENTAL HEALTH COUN
Credential: LMHC MA BSN RN
Phone: 260-804-9563