Provider Demographics
NPI:1184189714
Name:SUCCESS PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:SUCCESS PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-965-6135
Mailing Address - Street 1:2239 CARTER AVE # 202
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1638
Mailing Address - Country:US
Mailing Address - Phone:612-965-6135
Mailing Address - Fax:651-645-2439
Practice Address - Street 1:2239 CARTER AVE # 202
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1638
Practice Address - Country:US
Practice Address - Phone:612-965-6135
Practice Address - Fax:651-645-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health