Healthcare Provider Details

I. General information

NPI: 1861907339
Provider Name (Legal Business Name): THE CENTER FOR PROGRESS AND EXCELLENCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 FAIRWAY LAKES DR STE 4
FORT MYERS FL
33913-8385
US

IV. Provider business mailing address

11940 FAIRWAY LAKES DR STE 4
FORT MYERS FL
33913-8385
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-8490
  • Fax: 239-689-8103
Mailing address:
  • Phone: 239-689-8490
  • Fax: 239-689-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAN-PAUL MOJICA
Title or Position: CEO
Credential: LCSW
Phone: 239-689-8490