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General NPI Number Information
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NPI Number | 1528426293
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE LIFE INSTITUTE INC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 1933 MONTANA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1817
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Country | US
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Telephone | 202-349-7663
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Fax | 202-842-0604
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Provider Business Mailing Address
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Address Line | 1933 MONTANA AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1817
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Country | US
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Telephone | 202-349-7663
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Fax | 202-842-0604
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERICK BRIAN PHILLIPS
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Credential | PSY.D.
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Telephone | 202-349-7663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC301232
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License Number State | DC
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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 | PSY 1060
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License Number State | DC
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