Provider Demographics
NPI:1174745566
Name:KASSAR, BRIAN D (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:KASSAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5131
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-5131
Mailing Address - Country:US
Mailing Address - Phone:406-585-0526
Mailing Address - Fax:
Practice Address - Street 1:24 S WILLSON AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4609
Practice Address - Country:US
Practice Address - Phone:406-570-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT341103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT745203OtherBCBS PROVIDER #-PRIV PRAC
MT745203OtherBCBS PROVIDER #-PRIV PRAC