Provider Demographics
NPI:1043857949
Name:PROGRESSIVE CLINICAL THERAPIES LTD
Entity type:Organization
Organization Name:PROGRESSIVE CLINICAL THERAPIES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-666-4543
Mailing Address - Street 1:305 SAN CARLOS RD
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9246
Mailing Address - Country:US
Mailing Address - Phone:815-666-4543
Mailing Address - Fax:
Practice Address - Street 1:305 SAN CARLOS RD
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9246
Practice Address - Country:US
Practice Address - Phone:815-666-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty