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General NPI Number Information
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NPI Number | 1235882192
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PSYCHOLOGY, INC.
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1320 N CAMPBELL RD STE 13
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City | ROYAL OAK
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State | MI
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Zip | 48067-1555
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Country | US
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Telephone | 248-890-3590
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 MOHAWK AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3334
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Country | US
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Telephone | 248-890-3590
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTI FELIX
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Credential |
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Telephone | 586-337-3191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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