Healthcare Provider Details

I. General information

NPI: 1811639685
Provider Name (Legal Business Name): PROGRESSIVE PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
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: 702-778-7632
Mailing address:
  • Phone: 702-899-1208
  • Fax: 702-778-7632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AKINYEMI AKINWUMIJU
Title or Position: OWNER
Credential: MD
Phone: 702-899-1208