Provider Demographics
NPI:1184303208
Name:SANDBULTE LLC
Entity type:Organization
Organization Name:SANDBULTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANDBULTE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:605-906-3329
Mailing Address - Street 1:1601 E 69TH STR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8322
Mailing Address - Country:US
Mailing Address - Phone:605-906-3329
Mailing Address - Fax:877-814-0028
Practice Address - Street 1:1601 E. 69TH STR
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-906-3329
Practice Address - Fax:877-814-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty