Organization
PROGRESSIVE BEHAVIOR SERVICES
Active
Organization
PROGRESSIVE BEHAVIOR SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK W WISEMAN LPC (OWNER)
(208) 316-1237
Entity
Organization
Contact information
Practice address
8276 N WAYNE BLVD, HAYDEN, ID 83835
(208) 762-4618
Mailing address
523 GOLDEN WILLOW DR, REXBURG, ID 83440-5270
(208) 316-1238
(208) 359-5452
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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