Provider Demographics
NPI:1376311316
Name:PROGRESSIVE MINDS THERAPY
Entity Type:Organization
Organization Name:PROGRESSIVE MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MCAP
Authorized Official - Phone:850-480-9314
Mailing Address - Street 1:120 CHIEFS WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-1100
Mailing Address - Country:US
Mailing Address - Phone:850-480-9314
Mailing Address - Fax:
Practice Address - Street 1:4210 BURTONWOOD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-8013
Practice Address - Country:US
Practice Address - Phone:850-480-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHELLE LAWRENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty