Organization
PROTEA HEALTH LLC
Active
Other names
Protea Health LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FARDOWSA HASSAN IMAN LADC (CLINICAL DIRECTOR)
(320) 420-4469
Entity
Organization
Contact information
Practice address
720 8TH AVE N, SAINT CLOUD, MN 56303-3420
(320) 420-4469
Mailing address
720 8TH AVE N, SAINT CLOUD, MN 56303-3420
(320) 420-4469
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
05/04/2024
Last updated
05/04/2024
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