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General NPI Number Information
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NPI Number | 1558062265
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Entity Type | Organization
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Legal Business Name | PROGENY TMS CORPORATION
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 17782 COWAN STE D
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City | IRVINE
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State | CA
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Zip | 92614-6088
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Country | US
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Telephone | 817-680-5041
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Fax |
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Provider Business Mailing Address
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Address Line | 17782 COWAN STE A
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City | IRVINE
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State | CA
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Zip | 92614-6041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JADA ALSTON
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Credential | NP
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Telephone | 817-680-5041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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