Provider Demographics
NPI:1316517956
Name:BUDUL, FARHIA DAHIR (CPRS, CPP)
Entity type:Individual
Prefix:
First Name:FARHIA
Middle Name:DAHIR
Last Name:BUDUL
Suffix:
Gender:F
Credentials:CPRS, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 15TH AVE S UNIT 510
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1578
Mailing Address - Country:US
Mailing Address - Phone:612-226-4012
Mailing Address - Fax:
Practice Address - Street 1:515 15TH AVE S UNIT 510
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1578
Practice Address - Country:US
Practice Address - Phone:612-226-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8138405300000X
MN8227175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No405300000XOther Service ProvidersPrevention Professional