Provider Demographics
NPI:1689684995
Name:OGATA-SCHURE, TOMOMI (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:TOMOMI
Middle Name:
Last Name:OGATA-SCHURE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:TOMOMI
Other - Middle Name:
Other - Last Name:OGATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 COVEY CT UNIT D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8350
Mailing Address - Country:US
Mailing Address - Phone:406-581-7597
Mailing Address - Fax:
Practice Address - Street 1:104 COVEY CT UNIT D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8350
Practice Address - Country:US
Practice Address - Phone:406-581-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-12018101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT266668OtherNEW WEST HEALTH SERVICES
MT0257329Medicaid
611940300OtherDOL FECA
MT743560OtherBLUECROSS BLUESHIELD