Provider Demographics
NPI:1811379902
Name:BOZEMAN WELLNESS COUNSELING PLLC
Entity Type:Organization
Organization Name:BOZEMAN WELLNESS COUNSELING PLLC
Other - Org Name:TOMO OGATA-SCHURE LCPC
Other - Org Type:Other Name
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:TOMOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OGATA-SCHURE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:406-581-7597
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:
Mailing Address - Fax:
Practice Address - Street 1:2135 CHARLOTTE ST STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2741
Practice Address - Country:US
Practice Address - Phone:406-581-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-LIC-12018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty