Healthcare Provider Details

I. General information

NPI: 1083346621
Provider Name (Legal Business Name): FAHMO HANS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 2ND AVE S STE 2001091
MINNEAPOLIS MN
55401-5500
US

IV. Provider business mailing address

330 2ND AVE S STE 2001091
MINNEAPOLIS MN
55401-5500
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-0772
  • Fax:
Mailing address:
  • Phone: 734-747-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC03644
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: