Healthcare Provider Details

I. General information

NPI: 1750150330
Provider Name (Legal Business Name): BELSTI YESHEALEM MULUNEH PMHNP STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 NE HALSEY ST STE 206
PORTLAND OR
97220-5670
US

IV. Provider business mailing address

23501 E PORTLAND WAY
AURORA CO
80016-2436
US

V. Phone/Fax

Practice location:
  • Phone: 971-362-2896
  • Fax:
Mailing address:
  • Phone: 713-324-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1656734
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10054863
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: