Provider Demographics
NPI:1104517135
Name:PROGRESSIONS THERAPY PRACTICE, LLC
Entity type:Organization
Organization Name:PROGRESSIONS THERAPY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTERS SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARLA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-755-0055
Mailing Address - Street 1:1584 BERKLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1878
Mailing Address - Country:US
Mailing Address - Phone:517-755-0055
Mailing Address - Fax:
Practice Address - Street 1:1584 BERKLEY DR
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1878
Practice Address - Country:US
Practice Address - Phone:517-755-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty