MEDICARE: POSITIVE PROGRESS CLINICAL COUNSELING & COACHING PLLC

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	251S00000X	Community/Behavioral Health Agency	SW7100	FL

General Provider Information

NPI Number	:	1972991636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE PROGRESS CLINICAL COUNSELING & COACHING PLLC

Provider Business Mailing Address
First Line	:	1222 SE 47TH ST STE 217
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-829-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 SE 47TH ST STE 217
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9661
Country	:	US
Telephone Number	:	239-829-5480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICK MERILLAT
Credential	:
Telephone Number	:	239-829-5480

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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