Provider Demographics
NPI:1083122956
Name:ENDERES, CHRISTINA MAUREEN (PCLC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MAUREEN
Last Name:ENDERES
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-0409
Mailing Address - Country:US
Mailing Address - Phone:406-570-0754
Mailing Address - Fax:
Practice Address - Street 1:316 3RD AVE E
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-9160
Practice Address - Country:US
Practice Address - Phone:406-570-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-29493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty