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General NPI Number Information
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NPI Number | 1932972247
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Entity Type | Organization
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Legal Business Name | PRO HEALTH PSYCHIATRY NURSING CORPORATION
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 4533 MACARTHUR BLVD STE A-2068
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2059
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Country | US
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Telephone | 562-833-0518
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Fax |
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Provider Business Mailing Address
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Address Line | 4533 MACARTHUR BLVD STE A-2068
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2059
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Country | US
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Telephone | 562-833-0518
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACOB OLSEN
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Credential | PMHNP
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Telephone | 562-833-0518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 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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