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General NPI Number Information
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NPI Number | 1811402696
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Entity Type | Organization
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Legal Business Name | SUCCESSFUL TREATMENTS, LLC
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Dates
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Enumeration Date | 12/03/2017
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 18 VIA ARMILLA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-7204
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Country | US
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Telephone | 949-388-1953
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 E LA PALMA AVE APT 324
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City | ANAHEIM
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State | CA
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Zip | 92806-2158
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Country | US
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Telephone | 714-856-0620
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | DR. LORNA S PHAM
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Credential | PSYD
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Telephone | 949-237-0893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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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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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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