Healthcare Provider Details

I. General information

NPI: 1063524692
Provider Name (Legal Business Name): BRADLEY KENT LAMBSON LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 S WOODRUFF AVE
IDAHO FALLS ID
83401-5596
US

IV. Provider business mailing address

2184 CHANNING WAY PMB 260
IDAHO FALLS ID
83404-8034
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9294
  • Fax: 208-902-3772
Mailing address:
  • Phone: 208-569-4316
  • Fax: 208-902-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-4424
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: