Healthcare Provider Details

I. General information

NPI: 1417561994
Provider Name (Legal Business Name): KRISTI MOBLEY MED EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MOBLEY RD
OLIVE MT
59343-9602
US

IV. Provider business mailing address

16 MOBLEY RD
OLIVE MT
59343-9602
US

V. Phone/Fax

Practice location:
  • Phone: 406-698-9597
  • Fax:
Mailing address:
  • Phone: 406-698-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number282251
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number282251
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: