Active NPI
Shamso Iman
- Addiction (Substance Use Disorder) Counselor
- Sartell, MN
National Provider Identifier
1386412229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 305859
- Practice address
- 1908 Kruchten CT S
Sartell, MN 56377-4645 - Phone
- (320) 640-7660
- Fax
- (320) 774-1104
- NPI assigned
- Dec 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305859 | MN | Primary |
Addresses
Primary practice location
1908 Kruchten CT S
Sartell, MN 56377-4645
Mailing address
720 8TH Ave N
Saint Cloud, MN 56303-3420
Phone (320) 420-4469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305859 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714780800000",
"number": "1386412229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 8TH AVE N",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563033420",
"telephone_number": "320-420-4469",
"fax_number": "320-774-1104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1908 KRUCHTEN CT S",
"city": "SARTELL",
"state": "MN",
"postal_code": "563774645",
"telephone_number": "320-640-7660",
"fax_number": "320-774-1104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMAN",
"first_name": "SHAMSO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-19",
"last_updated": "2024-05-04",
"certification_date": "2024-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "305859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sartell, MN
- Matthew Ronald Hwang, M.D.
- I-Implant Dentistry
- Mariam Muhiddin Ibrahim
- Nawal Aden Ibrahim
- Ubah Afi Ibrahim
- Independent Living Services of Central Minnesota (Ilscm)
- Integracare LTD (Williams Integracare Clinic)
- Integracare LTD (Williams/Integracare Clinic)
- Interventional Pain & Physical Medicine Clinic
- Interventional Pain & Physical Medicine Clinic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.