Provider Demographics
NPI:1922454610
Name:YOSHIMURA, CHRISTINA (MA, PCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:YOSHIMURA
Suffix:
Gender:F
Credentials:MA, PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2437
Mailing Address - Country:US
Mailing Address - Phone:406-544-0253
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MONTANA
Practice Address - Street 2:32 CAMPUS DRIVE
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-16345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health