Provider Demographics
NPI:1144786245
Name:CENTER FOR PROGRESSIVE THERAPIES LLC
Entity Type:Organization
Organization Name:CENTER FOR PROGRESSIVE THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYSTI
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:480-223-8263
Mailing Address - Street 1:11011 S 48TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1787
Mailing Address - Country:US
Mailing Address - Phone:480-223-8263
Mailing Address - Fax:
Practice Address - Street 1:11011 S 48TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1787
Practice Address - Country:US
Practice Address - Phone:480-223-8263
Practice Address - Fax:480-247-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty