Provider Demographics
NPI:1033650536
Name:ROARK CAIRES, BRANDYN JEAN (MS)
Entity Type:Individual
Prefix:MS
First Name:BRANDYN
Middle Name:JEAN
Last Name:ROARK CAIRES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BRANDYN
Other - Middle Name:JEAN
Other - Last Name:ROARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 E OAK ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2972
Mailing Address - Country:US
Mailing Address - Phone:206-790-6750
Mailing Address - Fax:
Practice Address - Street 1:113 E OAK ST STE 2D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2972
Practice Address - Country:US
Practice Address - Phone:206-790-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-23438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health