Provider Demographics
NPI:1568868057
Name:KIMURA, SCOTT MAKOTO (MA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MAKOTO
Last Name:KIMURA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 NW SUNRISE CT.
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:971-241-4149
Mailing Address - Fax:
Practice Address - Street 1:1188 NW SUNRISE CT
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9515
Practice Address - Country:US
Practice Address - Phone:971-241-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health