Provider Demographics
NPI:1922739663
Name:HAJI BARE, UREJO HASSAN
Entity Type:Individual
Prefix:
First Name:UREJO
Middle Name:HASSAN
Last Name:HAJI BARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 W NOVAK WAY
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2995
Mailing Address - Country:US
Mailing Address - Phone:623-218-8074
Mailing Address - Fax:
Practice Address - Street 1:5308 W NOVAK WAY
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2995
Practice Address - Country:US
Practice Address - Phone:623-218-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH7631101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH7631OtherARIZONA DEPARTMENT OF HEALTH SERVICES