Provider Demographics
NPI:1912664079
Name:HAILLE, SAMATALIS HUSSEIN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:SAMATALIS
Middle Name:HUSSEIN
Last Name:HAILLE
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1330
Mailing Address - Country:US
Mailing Address - Phone:612-735-6673
Mailing Address - Fax:
Practice Address - Street 1:110 DIVISION ST
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1330
Practice Address - Country:US
Practice Address - Phone:612-735-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02336101YM0800X, 101YP2500X
MN3240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health