Provider Demographics
NPI:1568509032
Name:SUCCESSFUL OUTCOMES,LLC
Entity Type:Organization
Organization Name:SUCCESSFUL OUTCOMES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MED, LPC
Authorized Official - Phone:314-795-2428
Mailing Address - Street 1:1532 CLAUDINE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2339
Mailing Address - Country:US
Mailing Address - Phone:314-795-2428
Mailing Address - Fax:314-385-2363
Practice Address - Street 1:9167 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1420
Practice Address - Country:US
Practice Address - Phone:314-795-2428
Practice Address - Fax:314-385-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497184507Medicaid
MOSDA3992077OtherCTS