Healthcare Provider Details

I. General information

NPI: 1740366749
Provider Name (Legal Business Name): SUCCESS COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 W 168TH STREET
BRONX NY
10452-5401
US

IV. Provider business mailing address

139 W 168TH STREET
BRONX NY
10452-5401
US

V. Phone/Fax

Practice location:
  • Phone: 718-538-6112
  • Fax: 718-992-3584
Mailing address:
  • Phone: 718-538-6112
  • Fax: 718-992-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number051111032
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY G FRUIT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 608-347-6649