Organization
PHOENIX ASSOCIATES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WILLIAM BLANKS JR. MSW, LCSW (PRESIDENT)
(260) 424-0411
Entity
Organization
Contact information
Practice address
2200 LAKE AVE, SUITE 260, FORT WAYNE, IN 46805-5397
(260) 424-0411
(260) 424-3530
Mailing address
2200 LAKE AVE, SUITE 260, FORT WAYNE, IN 46805-5397
(260) 424-0411
(260) 424-3530
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000785A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080580A
—
IN
Enumeration date
12/12/2006
Last updated
04/02/2022
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