Provider Demographics
NPI:1164855433
Name:FUJIURA, KRISTY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:FUJIURA
Suffix:
Gender:F
Credentials:PSYD
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 587
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-0587
Mailing Address - Country:US
Mailing Address - Phone:269-447-2100
Mailing Address - Fax:
Practice Address - Street 1:6701 ALONGSIDE LN
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8633
Practice Address - Country:US
Practice Address - Phone:269-447-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical