MEDICARE: SUCCESSFUL TREATMENTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1811402696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESSFUL TREATMENTS, LLC

Provider Business Mailing Address
First Line	:	3530 E LA PALMA AVE APT 324
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-2158
Country	:	US
Telephone Number	:	714-856-0620
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 VIA ARMILLA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-7204
Country	:	US
Telephone Number	:	949-388-1953
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	DR. LORNA S PHAM
Credential	:	PSYD
Telephone Number	:	949-237-0893

Provider Enumeration Date	:	12/03/2017
Last Update Date	:	05/03/2018

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