Healthcare Provider Details

I. General information

NPI: 1326663337
Provider Name (Legal Business Name): ADAM BRYCE SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 W STATE ST STE 303
BOISE ID
83703
US

IV. Provider business mailing address

6126 W STATE ST STE 303
BOISE ID
83703-2741
US

V. Phone/Fax

Practice location:
  • Phone: 208-391-5047
  • Fax: 208-247-0595
Mailing address:
  • Phone: 208-391-5047
  • Fax: 208-247-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-7811
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: