Provider Demographics
NPI:1487532115
Name:BROWN, CASSIDY (MA,)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 S 18TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6267
Mailing Address - Country:US
Mailing Address - Phone:912-247-8305
Mailing Address - Fax:
Practice Address - Street 1:1609 W BABCOCK ST STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4018
Practice Address - Country:US
Practice Address - Phone:912-247-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCL-LIC-81103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health