Provider Demographics
NPI:1235994401
Name:HELLSTROM, JOSHUA KENJI RAOUL (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:KENJI RAOUL
Last Name:HELLSTROM
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1543
Mailing Address - Country:US
Mailing Address - Phone:503-913-5629
Mailing Address - Fax:
Practice Address - Street 1:44882 MISSION RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9293
Practice Address - Country:US
Practice Address - Phone:541-429-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10022053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty