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General NPI Number Information
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NPI Number | 1376311316
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE MINDS THERAPY
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 4210 BURTONWOOD DR
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City | PENSACOLA
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State | FL
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Zip | 32514-8013
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Country | US
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Telephone | 850-480-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CHIEFS WAY STE 1
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City | PENSACOLA
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State | FL
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Zip | 32507-1100
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Country | US
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Telephone | 850-480-9314
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MICHELLE M LAWRENCE
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Credential | LMHC, MCAP
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Telephone | 850-480-9314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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