Healthcare Provider Details

I. General information

NPI: 1366458903
Provider Name (Legal Business Name): DORRIT KARASEK LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E. BROADWAY, SUITE 16
MISSOULA MT
59802
US

IV. Provider business mailing address

PO BOX 8512
MISSOULA MT
59807
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-6065
  • Fax:
Mailing address:
  • Phone: 406-404-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number820
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: