Healthcare Provider Details

I. General information

NPI: 1508491499
Provider Name (Legal Business Name): KARELIA MOWBRAY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARI MOWBRAY

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W PINE ST STE 2
MISSOULA MT
59802-4222
US

IV. Provider business mailing address

114 W PINE ST STE 2
MISSOULA MT
59802-4222
US

V. Phone/Fax

Practice location:
  • Phone: 406-212-2456
  • Fax: 307-333-0843
Mailing address:
  • Phone: 406-212-2456
  • Fax: 307-333-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-57440
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: