Provider Demographics
NPI:1417561994
Name:MOBLEY, KRISTI (MED EDS)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MED EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOBLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59343-9602
Mailing Address - Country:US
Mailing Address - Phone:406-698-9597
Mailing Address - Fax:
Practice Address - Street 1:16 MOBLEY RD
Practice Address - Street 2:
Practice Address - City:OLIVE
Practice Address - State:MT
Practice Address - Zip Code:59343-9602
Practice Address - Country:US
Practice Address - Phone:406-698-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2822511041S0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool