Provider Demographics
NPI:1346947892
Name:SUPPORTIVE SERVICES LLC
Entity Type:Organization
Organization Name:SUPPORTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC-II
Authorized Official - Phone:901-517-7471
Mailing Address - Street 1:812 ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4331
Mailing Address - Country:US
Mailing Address - Phone:901-517-7471
Mailing Address - Fax:662-510-2527
Practice Address - Street 1:8830 CENTRE ST
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2609
Practice Address - Country:US
Practice Address - Phone:662-510-2523
Practice Address - Fax:662-510-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty