Provider Demographics
NPI:1154101541
Name:SEGED, EYOEL HAFTE
Entity type:Individual
Prefix:
First Name:EYOEL
Middle Name:HAFTE
Last Name:SEGED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 UNIVERSITY AVE W STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1629
Mailing Address - Country:US
Mailing Address - Phone:720-519-9476
Mailing Address - Fax:
Practice Address - Street 1:2233 UNIVERSITY AVE W STE 150
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1629
Practice Address - Country:US
Practice Address - Phone:720-519-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty