Healthcare Provider Details

I. General information

NPI: 1356841076
Provider Name (Legal Business Name): KURT BRADFORD SMITH CADC II, CRM, QMHA I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 SHERMAN AVE
NORTH BEND OR
97459-2872
US

IV. Provider business mailing address

1942 SHERIDAN AVE
NORTH BEND OR
97459-3416
US

V. Phone/Fax

Practice location:
  • Phone: 541-217-5239
  • Fax: 541-808-3134
Mailing address:
  • Phone: 541-435-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number16-CRM-084
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18-09-40
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19-QMHA-I-00673
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: