MEDICARE: PROGRESSIONS TLC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	190768AP	CA
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	190768AP	CA
3	324500000X	Substance Abuse Rehabilitation Facility	190768AP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190768AP	OTHER	CA	CALIFORNIA DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS LICENSE AND CERTIFICATION

General Provider Information

NPI Number	:	1689916827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIONS TLC LLC

Provider Business Mailing Address
First Line	:	PO BOX 6032
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91365-6032
Country	:	US
Telephone Number	:	818-324-2507
Fax Number	:	888-310-4278

Provider Business Practice Location Address
First Line	:	5510 WILBUR AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-3219
Country	:	US
Telephone Number	:	818-324-2507
Fax Number	:	888-310-3278

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. RHONDA LEE KIRKPATRICK
Credential	:	RS, RW
Telephone Number	:	818-324-2507

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2013

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Directions to “PROGRESSIONS TLC LLC ” Practice Location

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