Provider Demographics
NPI:1437915303
Name:DUBOSE, BRYNN
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 N 1ST ST APT B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3198
Mailing Address - Country:US
Mailing Address - Phone:406-361-0110
Mailing Address - Fax:406-573-1080
Practice Address - Street 1:1967 N 1ST ST APT B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3198
Practice Address - Country:US
Practice Address - Phone:406-361-0110
Practice Address - Fax:406-573-1080
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-647151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical