Healthcare Provider Details

I. General information

NPI: 1215627633
Provider Name (Legal Business Name): KRISTINA EMANUEL DOVRE MS, NCC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA EMANUEL BRAKEBUSH MS, NCC, LCPC

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 BEVERLY HILL BLVD
BILLINGS MT
59102-2311
US

IV. Provider business mailing address

PO BOX 187
LIBERTY LAKE WA
99019-0187
US

V. Phone/Fax

Practice location:
  • Phone: 406-671-4295
  • Fax:
Mailing address:
  • Phone: 406-671-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61612267
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60135
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: