Provider Demographics
NPI:1487218517
Name:SHORE, CHRISTINA JOY (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOY
Last Name:SHORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 ONEAL CIR APT K30
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1471
Mailing Address - Country:US
Mailing Address - Phone:847-571-6630
Mailing Address - Fax:
Practice Address - Street 1:2300 CANYON BLVD STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5619
Practice Address - Country:US
Practice Address - Phone:720-318-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health