Mouktar Bouraleh

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

4470 W 78TH Street Cir
Bloomington, MN 55435-5408

Phone

(770) 713-7467

NPI assigned

Jun 27, 2025

Last updated

Jun 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Star Therapy

  • Community/Behavioral Health Agency
  • Bloomington, MN
  • NPI 1669361499
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1467341297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 HUMBOLDT AVE S # 402",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4470 W 78TH STREET CIR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355408",
            "telephone_number": "770-713-7467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURALEH",
        "first_name": "MOUKTAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-27",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bottelson Enterprises
• Randall Andrew Bottelson, BS
• John William Bottoms, PT
• Lisa Paull Boudreau
• Mark Boudreau, PHARMD
• Christina Danielle Bourgeois, LPCC
• Hannah Marie Bowers
• Angela Bowles Edwards, CHW
• Leslie Boyle-Milroy, LAMFT
• Lisa Braatz, CNP

• Behavior Analyst in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Behavior Analyst in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.