Provider Demographics
NPI:1952637357
Name:HELLSTROM, ELIZABETH G (CL)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:HELLSTROM
Suffix:
Gender:F
Credentials:CL
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CL
Mailing Address - Street 1:3923 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1085
Mailing Address - Country:US
Mailing Address - Phone:765-962-0521
Mailing Address - Fax:
Practice Address - Street 1:3923 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1085
Practice Address - Country:US
Practice Address - Phone:765-962-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)