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General NPI Number Information
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NPI Number | 1568509032
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Entity Type | Organization
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Legal Business Name | SUCCESSFUL OUTCOMES,LLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 9167 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-1420
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Country | US
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Telephone | 314-795-2428
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Fax | 314-385-2363
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Provider Business Mailing Address
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Address Line | 1532 CLAUDINE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63138-2339
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Country | US
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Telephone | 314-795-2428
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Fax | 314-385-2363
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Authorized Official
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Title or Position | DIRECTOR
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Name | VALERIE ANITA ATKINS
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Credential | M.A., M.ED., LPC
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Telephone | 314-795-2428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2005009393
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License Number State | MO
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