Healthcare Provider Details

I. General information

NPI: 1255242368
Provider Name (Legal Business Name): ALEXANDRA CORBETT MSW, SWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEX CORBETT

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 S 3RD ST W
MISSOULA MT
59804-1139
US

IV. Provider business mailing address

550 N CALIFORNIA ST
MISSOULA MT
59802-3913
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-3029
  • Fax:
Mailing address:
  • Phone: 406-461-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-90568
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: