Provider Demographics
NPI:1538490354
Name:SUCCESS ON PURPOSE
Entity Type:Organization
Organization Name:SUCCESS ON PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:972-298-3614
Mailing Address - Street 1:PO BOX 380128
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75138-0128
Mailing Address - Country:US
Mailing Address - Phone:972-298-3614
Mailing Address - Fax:972-709-8145
Practice Address - Street 1:402 W DANIELDALE RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3928
Practice Address - Country:US
Practice Address - Phone:972-298-3614
Practice Address - Fax:972-709-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty