Provider Demographics
NPI:1093028391
Name:HELLUM, KRISTY LYNN (MFT)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:HELLUM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:HELLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:3759 SE FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1832
Mailing Address - Country:US
Mailing Address - Phone:503-863-7900
Mailing Address - Fax:
Practice Address - Street 1:5441 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1837
Practice Address - Country:US
Practice Address - Phone:503-863-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44973101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional