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General NPI Number Information
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NPI Number | 1396490256
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Entity Type | Organization
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Legal Business Name | BUILDING A STRONGER FAMILY
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 201 E RUDISILL BLVD STE B102
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City | FORT WAYNE
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State | IN
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Zip | 46806-1756
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Country | US
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Telephone | 260-797-5892
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Fax |
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Provider Business Mailing Address
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Address Line | 921 E DUPONT RD # 909
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City | FORT WAYNE
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State | IN
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Zip | 46825-1551
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Country | US
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Telephone | 260-797-5892
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | MR. JONATHON NEAL WATTLEY
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Credential |
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Telephone | 260-797-5892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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