Provider Demographics
NPI:1518602176
Name:BODHI EDUCATION SERVICES, LLC
Entity Type:Organization
Organization Name:BODHI EDUCATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:706-834-0139
Mailing Address - Street 1:5433 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR TOWNSHIP
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5770
Mailing Address - Country:US
Mailing Address - Phone:706-834-0139
Mailing Address - Fax:
Practice Address - Street 1:5433 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:WHITE BEAR TOWNSHIP
Practice Address - State:MN
Practice Address - Zip Code:55110-5770
Practice Address - Country:US
Practice Address - Phone:706-834-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty