Provider Demographics
NPI:1215627633
Name:DOVRE, KRISTINA EMANUEL (MS, NCC, LCPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:EMANUEL
Last Name:DOVRE
Suffix:
Gender:F
Credentials:MS, NCC, LCPC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:EMANUEL
Other - Last Name:BRAKEBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, LCPC
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0187
Mailing Address - Country:US
Mailing Address - Phone:406-241-6699
Mailing Address - Fax:
Practice Address - Street 1:22751 E APPLEWAY AVE # G9
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8511
Practice Address - Country:US
Practice Address - Phone:406-241-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT60135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health