Provider Demographics
NPI:1932597309
Name:2BESUCCESSFUL
Entity type:Organization
Organization Name:2BESUCCESSFUL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-260-9774
Mailing Address - Street 1:300 N 5TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1447
Mailing Address - Country:US
Mailing Address - Phone:734-222-9277
Mailing Address - Fax:734-222-9277
Practice Address - Street 1:300 N 5TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1447
Practice Address - Country:US
Practice Address - Phone:734-222-9277
Practice Address - Fax:734-222-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011420261QM0855X
MI6301005474261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health