Provider Demographics
NPI:1992470546
Name:SUCCESS ON THE SPECTRUM PPCC INC
Entity type:Organization
Organization Name:SUCCESS ON THE SPECTRUM PPCC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-642-6715
Mailing Address - Street 1:4400 CALL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2446
Mailing Address - Country:US
Mailing Address - Phone:940-692-0165
Mailing Address - Fax:
Practice Address - Street 1:5816 ASHLEYANNE CIR STE 400
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1613
Practice Address - Country:US
Practice Address - Phone:940-692-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty