Provider Demographics
NPI:1861939696
Name:PROGRESSIVE WELLNESS CENTER
Entity type:Organization
Organization Name:PROGRESSIVE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-232-7711
Mailing Address - Street 1:9628 CAMPO RD STE U
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1227
Mailing Address - Country:US
Mailing Address - Phone:858-232-7711
Mailing Address - Fax:
Practice Address - Street 1:9628 CAMPO RD STE U
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1227
Practice Address - Country:US
Practice Address - Phone:858-232-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health