Provider Demographics
NPI:1497263735
Name:KARINEN, ELI
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:KARINEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 W BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2315
Mailing Address - Country:US
Mailing Address - Phone:406-707-0640
Mailing Address - Fax:
Practice Address - Street 1:1124 W BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2315
Practice Address - Country:US
Practice Address - Phone:406-707-0640
Practice Address - Fax:406-350-3004
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-25637101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health