MEDICARE: PROGRESSIVE PSYCHIATRIC SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician

General Provider Information

NPI Number	:	1235922295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PSYCHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	2830 S JONES BLVD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 S JONES BLVD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5652
Country	:	US
Telephone Number	:	702-899-1208
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TAMI VERNETTE BASS
Credential	:
Telephone Number	:	702-591-3055

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	05/23/2025

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