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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811639685
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	:	702-899-1208
Fax Number	:	702-778-7632

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	:	702-778-7632

Authorized Official
Title or Position	:	OWNER
Name	:	AKINYEMI AKINWUMIJU
Credential	:	MD
Telephone Number	:	702-899-1208

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	12/16/2024

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