Provider Demographics
NPI:1346602240
Name:PROGRESSIVE RECOVERY COUNSELING SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE RECOVERY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-518-3415
Mailing Address - Street 1:312 S CEDROS AVE
Mailing Address - Street 2:SUITE 334
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1979
Mailing Address - Country:US
Mailing Address - Phone:619-518-3415
Mailing Address - Fax:760-304-4080
Practice Address - Street 1:312 S CEDROS AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1979
Practice Address - Country:US
Practice Address - Phone:619-518-3415
Practice Address - Fax:760-304-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty