MEDICARE: BUILDING BLOCKS COUNSELING CENTER 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	101YM0800X	Mental Health Counselor	E0004334	OH

General Provider Information

NPI Number	:	1053623454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	7300 WHIPPLE AVE NW
Second Line	:	SUITE 1
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7159
Country	:	US
Telephone Number	:	330-433-2390
Fax Number	:	330-433-2391

Provider Business Practice Location Address
First Line	:	7300 WHIPPLE AVE NW
Second Line	:	SUITE 1
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7159
Country	:	US
Telephone Number	:	330-433-2390
Fax Number	:	330-433-2391

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SCARLET A RUE
Credential	:	MA, LPCC, NCC
Telephone Number	:	330-433-2390

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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