Healthcare Provider Details

I. General information

NPI: 1487825246
Provider Name (Legal Business Name): YUKO KISHIMOTO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 HALE PKWY STE 116
DENVER CO
80220-6203
US

IV. Provider business mailing address

903 UINTA WAY
DENVER CO
80230-6885
US

V. Phone/Fax

Practice location:
  • Phone: 303-564-4830
  • Fax:
Mailing address:
  • Phone: 303-564-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number33457
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4030
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4530
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: