Healthcare Provider Details

I. General information

NPI: 1235882192
Provider Name (Legal Business Name): PROGRESSIVE PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 N CAMPBELL RD STE 13
ROYAL OAK MI
48067-1555
US

IV. Provider business mailing address

1510 MOHAWK AVE
ROYAL OAK MI
48067-3334
US

V. Phone/Fax

Practice location:
  • Phone: 248-890-3590
  • Fax:
Mailing address:
  • Phone: 248-890-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTI FELIX
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-337-3191