Healthcare Provider Details

I. General information

NPI: 1659106441
Provider Name (Legal Business Name): CDA COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
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: 208-601-6162
Mailing address:
  • Phone: 509-989-4935
  • Fax: 208-601-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD RICHARD SMEDLEY
Title or Position: OWNER/OPERATOR
Credential: LMFT
Phone: 509-989-4935