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General NPI Number Information
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NPI Number | 1740366749
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Entity Type | Organization
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Legal Business Name | SUCCESS COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 139 W 168TH STREET
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City | BRONX
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State | NY
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Zip | 10452-5401
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Country | US
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Telephone | 718-538-6112
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Fax | 718-992-3584
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Provider Business Mailing Address
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Address Line | 139 W 168TH STREET
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City | BRONX
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State | NY
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Zip | 10452-5401
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Country | US
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Telephone | 718-538-6112
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Fax | 718-992-3584
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LARRY G FRUIT
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Credential |
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Telephone | 608-347-6649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 051111032
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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