Provider Demographics
NPI:1831073246
Name:SOUTHWORTH, KARLIE MICHELE (PCLC)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:MICHELE
Last Name:SOUTHWORTH
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S 6TH ST W APT 21
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3955
Mailing Address - Country:US
Mailing Address - Phone:406-366-6594
Mailing Address - Fax:
Practice Address - Street 1:313 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1405
Practice Address - Country:US
Practice Address - Phone:406-366-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-81008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health