Provider Demographics
NPI:1700086477
Name:SUCCESS CENTER INSTITUTE
Entity Type:Organization
Organization Name:SUCCESS CENTER INSTITUTE
Other - Org Name:THE SUCCESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-474-7601
Mailing Address - Street 1:2755 BERNICE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1040
Mailing Address - Country:US
Mailing Address - Phone:708-474-7601
Mailing Address - Fax:708-474-7615
Practice Address - Street 1:2755 BERNICE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1040
Practice Address - Country:US
Practice Address - Phone:708-474-7601
Practice Address - Fax:708-474-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty