Provider Demographics
NPI:1003507898
Name:PROGINOSKO BEHAVIORAL HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:PROGINOSKO BEHAVIORAL HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:NDLOVU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MDIV, MSW,LCSWS
Authorized Official - Phone:956-570-5110
Mailing Address - Street 1:PO BOX 4796
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4796
Mailing Address - Country:US
Mailing Address - Phone:956-570-5110
Mailing Address - Fax:956-679-3040
Practice Address - Street 1:5415 N MCCOLL RD STE 105
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4664
Practice Address - Country:US
Practice Address - Phone:956-570-5110
Practice Address - Fax:956-679-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2W2655OtherMEDICARE