Healthcare Provider Details

I. General information

NPI: 1740969070
Provider Name (Legal Business Name): JOSHUA SAMUEL ENJATI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 SW TUALATIN VALLEY HWY
BEAVERTON OR
97003-5143
US

IV. Provider business mailing address

2319 SE 61ST LN
HILLSBORO OR
97123-2939
US

V. Phone/Fax

Practice location:
  • Phone: 503-649-5651
  • Fax:
Mailing address:
  • Phone: 509-990-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR11066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: