Healthcare Provider Details

I. General information

NPI: 1891650362
Provider Name (Legal Business Name): BRETT ROES-HARTMAN MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRETT ROES

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 JACKSON BLVD STE 21
RAPID CITY SD
57702-3474
US

IV. Provider business mailing address

2650 JACKSON BLVD STE 5
RAPID CITY SD
57702-3474
US

V. Phone/Fax

Practice location:
  • Phone: 605-644-6021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC20954
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: