Provider Demographics
NPI:1508491499
Name:MOWBRAY, KARELIA (LCPC)
Entity Type:Individual
Prefix:
First Name:KARELIA
Middle Name:
Last Name:MOWBRAY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:
Other - Last Name:MOWBRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:WY
Mailing Address - Zip Code:83128-2608
Mailing Address - Country:US
Mailing Address - Phone:406-212-2456
Mailing Address - Fax:307-333-0843
Practice Address - Street 1:430 B STREET
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:WY
Practice Address - Zip Code:83112-9901
Practice Address - Country:US
Practice Address - Phone:406-212-2456
Practice Address - Fax:307-333-0843
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MTBBH-LCPC-LIC-57440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst