Healthcare Provider Details

I. General information

NPI: 1356825863
Provider Name (Legal Business Name): FATHI ABDIKARIM GELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 HUMBOLDT AVE S STE 217
BLOOMINGTON MN
55431-1432
US

IV. Provider business mailing address

8200 HUMBOLDT AVE S STE 217
BLOOMINGTON MN
55431-1432
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-7055
  • Fax: 612-605-3312
Mailing address:
  • Phone: 952-888-7055
  • Fax: 612-605-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: