Protea Psychological Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROTEA PSYCHOLOGICAL SERVICES LLC

Practice address

1923 J N Pease PL Ste 104
Charlotte, NC 28262-4534

Phone

(704) 668-6635

Fax

(541) 314-9554

NPI assigned

Dec 8, 2021

Organization subpart

No

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

Authorized official

Name

Latasha Miller, PSYDNPI 1467910836

Title

Owner

Phone

(704) 668-6635

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Latasha Miller, PSYD

  • Psychologist
  • Indian Trail, NC
  • NPI 1467910836
  NPD Authorized official

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

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1922766849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 J N PEASE PL STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624534",
            "telephone_number": "704-859-2762",
            "fax_number": "541-314-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 J N PEASE PL STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624534",
            "telephone_number": "704-668-6635",
            "fax_number": "541-314-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTEA PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-668-6635",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.