Organization
WILDROOTS COLLECTIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARELIA MOWBRAY LCPC (OWNER)
(406) 212-2456
Entity
Organization
Contact information
Practice address
430 B STREET, BEDFORD, WY 83112-9901
(406) 212-2456
(307) 333-0843
Mailing address
PO BOX 2829, ALPINE, WY 83128-2608
(307) 333-0843
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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