Provider Demographics
NPI:1902494883
Name:PROGRESSIVE MENTAL HEALTH CLINIC CORP
Entity type:Organization
Organization Name:PROGRESSIVE MENTAL HEALTH CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMPARO
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-465-9379
Mailing Address - Street 1:12595 SW 137TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4221
Mailing Address - Country:US
Mailing Address - Phone:305-465-9379
Mailing Address - Fax:
Practice Address - Street 1:12595 SW 137TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4221
Practice Address - Country:US
Practice Address - Phone:305-465-9379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty