=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457997496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUCCESS TMS PROFESSIONAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2019
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 WAUKEGAN RD STE 209&213
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-711-4867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 950510
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63195-0510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-711-4867
-----------------------------------------------------
Fax | 641-800-3145
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO & PRESIDENT
-----------------------------------------------------
Name | WILLIAM LEONARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-303-9821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------