Organization
PRO HEALTH PSYCHIATRY NURSING CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB OLSEN PMHNP (CEO)
(562) 833-0518
Entity
Organization
Contact information
Practice address
1 PARK PLZ STE 600, IRVINE, CA 92614-5987
(949) 828-1546
Mailing address
4533 MACARTHUR BLVD STE A-2068, NEWPORT BEACH, CA 92660-2059
(562) 833-0518
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/30/2023
Last updated
03/06/2026
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