Protea Health LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PROTEA HEALTH LLC

Practice address

720 8TH Ave N
Saint Cloud, MN 56303-3420

Phone

(320) 420-4469

NPI assigned

May 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Fardowsa Hassan Iman, LADCNPI 1730742172

Title

Clinical Director

Phone

(320) 420-4469

Specialties & licenses 2

Addresses

Other names 1

• Protea Health LLC Former legal business name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fardowsa Hassan Iman, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Saint Cloud, MN
  • NPI 1730742172
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714780800000",
    "number": "1508613795",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 8TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563033420",
            "telephone_number": "320-420-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTEA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-04",
        "last_updated": "2024-05-04",
        "certification_date": "2024-05-04",
        "status": "A",
        "authorized_official_last_name": "IMAN",
        "authorized_official_first_name": "FARDOWSA",
        "authorized_official_middle_name": "HASSAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "320-420-4469",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Protea Health LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• 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.

Verify at the official NPI Registry.