Provider Demographics
NPI:1457559395
Name:PROGRESSIVE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:TERRENCE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-648-4151
Mailing Address - Street 1:4409 FORBES BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4373
Mailing Address - Country:US
Mailing Address - Phone:301-648-4151
Mailing Address - Fax:
Practice Address - Street 1:4409 FORBES BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4373
Practice Address - Country:US
Practice Address - Phone:301-648-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty