Healthcare Provider Details

I. General information

NPI: 1669360830
Provider Name (Legal Business Name): NASTEHO IBRAHIM OKASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AMERICAN BLVD E STE 19
BLOOMINGTON MN
55425-1404
US

IV. Provider business mailing address

2001 KILLEBREW DR STE 112
BLOOMINGTON MN
55425-1871
US

V. Phone/Fax

Practice location:
  • Phone: 207-408-6684
  • Fax:
Mailing address:
  • Phone: 207-408-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: