=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295194066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRITE SUCCESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3023 WOODLAND HILLS DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-370-0522
-----------------------------------------------------
Fax | 888-501-0628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3007 WOODLAND HILLS DR SUITE 234
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-370-0522
-----------------------------------------------------
Fax | 888-501-0628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR
-----------------------------------------------------
Name | MELANIE JOHNSTON
-----------------------------------------------------
Credential | SLP-CCC
-----------------------------------------------------
Telephone | 713-370-0522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 12323
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------