Healthcare Provider Details

I. General information

NPI: 1356726145
Provider Name (Legal Business Name): BRAD RICHARD SMEDLEY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 N GOVERNMENT WAY STE 4
DALTON GARDENS ID
83815-9200
US

IV. Provider business mailing address

3675 N SCOTCH PINE LN APT 3
COEUR D ALENE ID
83815-1899
US

V. Phone/Fax

Practice location:
  • Phone: 509-989-4935
  • Fax:
Mailing address:
  • Phone: 509-989-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF60804635
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT-7872
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-7872
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: