Provider Demographics
NPI:1770174351
Name:PROGRESSIVE WELLNESS
Entity type:Organization
Organization Name:PROGRESSIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JINNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-534-1400
Mailing Address - Street 1:4777 ALBEN BARKLEY DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6789
Mailing Address - Country:US
Mailing Address - Phone:270-534-1400
Mailing Address - Fax:
Practice Address - Street 1:4777 ALBEN BARKLEY DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6789
Practice Address - Country:US
Practice Address - Phone:270-534-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty