Provider Demographics
NPI:1093474074
Name:PROGRESSING FORWARD MEDICAL AND MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PROGRESSING FORWARD MEDICAL AND MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:SHANAE
Authorized Official - Last Name:HYPOLITE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-439-5849
Mailing Address - Street 1:9000 NW 84TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8677
Mailing Address - Country:US
Mailing Address - Phone:405-439-5849
Mailing Address - Fax:310-356-0781
Practice Address - Street 1:611 OLD AGENCY DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7224
Practice Address - Country:US
Practice Address - Phone:405-439-5849
Practice Address - Fax:310-356-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty