Provider Demographics
NPI:1699806083
Name:YOSHIMURA, ELLEN CLAIRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CLAIRE
Last Name:YOSHIMURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S 6TH ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4031
Mailing Address - Country:US
Mailing Address - Phone:805-652-2283
Mailing Address - Fax:
Practice Address - Street 1:128 S 6TH ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4031
Practice Address - Country:US
Practice Address - Phone:805-652-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-1732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15099Medicare ID - Type Unspecified