| Progressive Life Counseling Llc | |
|
515 Airport Rd Centralia IL 62801-6583 | |
| (618) 316-3826 | |
| Not Available |
| Full Name | Progressive Life Counseling Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 515 Airport Rd, Centralia, Illinois |
| Authorized Official Name and Position | Destin Mays (PROVIDER/OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 6183163826 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Life Counseling Llc 24 Bel Air Dr Centralia IL 62801-6513 Ph: (618) 316-3826 | Progressive Life Counseling Llc 515 Airport Rd Centralia IL 62801-6583 Ph: (618) 316-3826 |
| NPI Number | 1538658372 |
|---|---|
| Provider Enumeration Date | 05/07/2018 |
| Last Update Date | 05/15/2024 |
| Certification Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538658372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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