Healthcare Provider Details

I. General information

NPI: 1831012624
Provider Name (Legal Business Name): SUCCESSFUL EDGE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 STATE LINE RD STE 203
KANSAS CITY MO
64114-2019
US

IV. Provider business mailing address

8301 STATE LINE RD STE 203
KANSAS CITY MO
64114-2019
US

V. Phone/Fax

Practice location:
  • Phone: 806-807-6605
  • Fax: 816-277-0256
Mailing address:
  • Phone: 816-807-6605
  • Fax: 816-277-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY ARCHIE
Title or Position: OWNER
Credential: LPC, LCPC
Phone: 816-807-6605