Healthcare Provider Details

I. General information

NPI: 1083122956
Provider Name (Legal Business Name): CHRISTINA MAUREEN ENDERES P.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 3RD AVE E
THREE FORKS MT
59752-9160
US

IV. Provider business mailing address

PO BOX 409
THREE FORKS MT
59752-0409
US

V. Phone/Fax

Practice location:
  • Phone: 406-570-0754
  • Fax:
Mailing address:
  • Phone: 406-570-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberBBH-PCLC-LIC-29493
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: