Healthcare Provider Details

I. General information

NPI: 1235922295
Provider Name (Legal Business Name): PROGRESSIVE PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 S JONES BLVD STE 3
LAS VEGAS NV
89146-5652
US

IV. Provider business mailing address

2830 S JONES BLVD STE 3
LAS VEGAS NV
89146-5652
US

V. Phone/Fax

Practice location:
  • Phone: 702-899-1208
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMI VERNETTE BASS
Title or Position: DIRECTOR
Credential:
Phone: 702-591-3055