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	:	1093590143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS COUNSELING,LLC

Provider Business Mailing Address
First Line	:	PO BOX 10690
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-0690
Country	:	US
Telephone Number	:	602-975-2194
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 E MCDOWELL RD STE 219
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4438
Country	:	US
Telephone Number	:	602-975-2194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VERN P JOHNSON
Credential	:
Telephone Number	:	602-626-8112

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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