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General NPI Number Information
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NPI Number | 1861939696
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE WELLNESS CENTER
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 9628 CAMPO RD STE U
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City | SPRING VALLEY
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State | CA
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Zip | 91977-1227
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Country | US
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Telephone | 858-232-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 9628 CAMPO RD STE U
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City | SPRING VALLEY
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State | CA
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Zip | 91977-1227
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Country | US
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Telephone | 858-232-7711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD KOHLER
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Credential | PSY.D
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Telephone | 858-232-7711
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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 |
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License Number State |
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