| Progressive Psychiatric Services, Llc | |
|
2830 S Jones Blvd Ste 3 Las Vegas NV 89146-5652 | |
| (702) 899-1208 | |
| (702) 778-7632 |
| Full Name | Progressive Psychiatric Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2830 S Jones Blvd Ste 3, Las Vegas, Nevada |
| Authorized Official Name and Position | Akinyemi Akinwumiju (OWNER) |
| Authorized Official Contact | 7026649150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Psychiatric Services, Llc 2830 S Jones Blvd Ste 3 Las Vegas NV 89146-5652 Ph: (702) 899-1208 | Progressive Psychiatric Services, Llc 2830 S Jones Blvd Ste 3 Las Vegas NV 89146-5652 Ph: (702) 899-1208 |
| NPI Number | 1811639685 |
|---|---|
| Provider Enumeration Date | 04/11/2022 |
| Last Update Date | 08/20/2024 |
| Certification Date | 08/20/2024 |
| Medicare PECOS PAC ID | 4789066622 |
|---|---|
| Medicare Enrollment ID | O20220809001750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811639685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Stephen H Frye |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164755328 PECOS PAC ID: 6103967229 Enrollment ID: I20100111000581 |
| Provider Name | Travis Chase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508255068 PECOS PAC ID: 8921379124 Enrollment ID: I20170807001791 |
| Provider Name | Ifeanyi C Madu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295295038 PECOS PAC ID: 2860729647 Enrollment ID: I20190816001757 |
| Provider Name | Hisbay H Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1306127311 PECOS PAC ID: 0446524565 Enrollment ID: I20210716002733 |
| Provider Name | Willie Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255588216 PECOS PAC ID: 7214364041 Enrollment ID: I20210805002845 |
| Provider Name | Jirair Maurice Baghdassarian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760068365 PECOS PAC ID: 0345638995 Enrollment ID: I20211101001110 |
| Provider Name | Onyekachi Bernadette Emereuwaonu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578201265 PECOS PAC ID: 8729460845 Enrollment ID: I20220804003889 |
| Provider Name | Edwige Hermine Fandio Ngankou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720865272 PECOS PAC ID: 9739538240 Enrollment ID: I20231208003156 |
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