Provider Demographics
NPI:1699780122
Name:SUCCESS COUNSELING SERVICES NORTH DBA SUCCESS INSITE
Entity type:Organization
Organization Name:SUCCESS COUNSELING SERVICES NORTH DBA SUCCESS INSITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-4299
Mailing Address - Street 1:1504 BARKSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4602
Mailing Address - Country:US
Mailing Address - Phone:318-222-4299
Mailing Address - Fax:318-425-2696
Practice Address - Street 1:1504 BARKSDALE BLVD
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4602
Practice Address - Country:US
Practice Address - Phone:318-222-4299
Practice Address - Fax:318-425-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1677574Medicaid