Healthcare Provider Details

I. General information

NPI: 1548121528
Provider Name (Legal Business Name): BRAINBOX PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MAIN ST SW
RONAN MT
59864-2705
US

IV. Provider business mailing address

PO BOX 115
DEAVER WY
82421-0115
US

V. Phone/Fax

Practice location:
  • Phone: 307-410-0794
  • Fax: 307-357-3150
Mailing address:
  • Phone: 307-410-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TARI ANN MCADAM
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 307-410-0794