Provider Demographics
NPI:1750747937
Name:SUCCESS 4 KIDS THERAPY
Entity type:Organization
Organization Name:SUCCESS 4 KIDS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON-GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-681-5181
Mailing Address - Street 1:11905 P ST
Mailing Address - Street 2:STE # 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2237
Mailing Address - Country:US
Mailing Address - Phone:402-681-5181
Mailing Address - Fax:402-884-0856
Practice Address - Street 1:11905 P ST
Practice Address - Street 2:STE # 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2237
Practice Address - Country:US
Practice Address - Phone:402-681-5181
Practice Address - Fax:402-884-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty