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General NPI Number Information
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NPI Number | 1649549940
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 8245 20TH AVE NE # 6
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City | SEATTLE
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State | WA
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Zip | 98115-4407
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Country | US
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Telephone | 206-659-7708
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Fax |
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Provider Business Mailing Address
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Address Line | 8245 20TH AVE NE # 6
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City | SEATTLE
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State | WA
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Zip | 98115-4407
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Country | US
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Telephone | 206-659-7708
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD THERAPIST
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Name | NICOLE E MAZEN
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Credential | LMFTA
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Telephone | 206-659-7708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MG 60138373
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License Number State | WA
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