Provider Demographics
NPI:1316018302
Name:KOSINE, BRANDON R (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:R
Last Name:KOSINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 1ST ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2558
Mailing Address - Country:US
Mailing Address - Phone:307-760-6538
Mailing Address - Fax:
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2558
Practice Address - Country:US
Practice Address - Phone:307-760-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health