Provider Demographics
NPI:1659136570
Name:PROTEA BEHAVIORAL HEALTH COUNSELING, PLLC
Entity Type:Organization
Organization Name:PROTEA BEHAVIORAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-393-0969
Mailing Address - Street 1:80 HIGHWAY 2227
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1562
Mailing Address - Country:US
Mailing Address - Phone:513-393-0969
Mailing Address - Fax:
Practice Address - Street 1:8963 KINGSRIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1623
Practice Address - Country:US
Practice Address - Phone:513-393-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROTEA BEHAVIORAL HEALTH COUNSELING PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490416Medicaid