Provider Demographics
NPI:1326810029
Name:BULE, SAMATAR HUSSEIN
Entity Type:Individual
Prefix:
First Name:SAMATAR
Middle Name:HUSSEIN
Last Name:BULE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 WEST END BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ST.LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-994-0909
Mailing Address - Fax:952-487-3216
Practice Address - Street 1:1650 WEST END BLVD
Practice Address - Street 2:
Practice Address - City:ST.LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-994-0909
Practice Address - Fax:952-487-3216
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician