Provider Demographics
NPI:1780818716
Name:PROGRESSIVE MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:DONESKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-840-4391
Mailing Address - Street 1:4849 S CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7432
Mailing Address - Country:US
Mailing Address - Phone:417-840-4391
Mailing Address - Fax:
Practice Address - Street 1:4849 S CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7432
Practice Address - Country:US
Practice Address - Phone:417-840-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003095103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty