Provider Demographics
NPI:1245499748
Name:RUSSEL A. HUNT, PMHNP, INC.
Entity type:Organization
Organization Name:RUSSEL A. HUNT, PMHNP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:541-963-7643
Mailing Address - Street 1:802 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2223
Mailing Address - Country:US
Mailing Address - Phone:541-963-7643
Mailing Address - Fax:541-962-0497
Practice Address - Street 1:802 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2223
Practice Address - Country:US
Practice Address - Phone:541-963-7643
Practice Address - Fax:541-962-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR88000353N6251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management