Healthcare Provider Details

I. General information

NPI: 1740836931
Provider Name (Legal Business Name): BRADLEY SMITH LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 W NOB HILL BLVD UNIT A
YAKIMA WA
98902-4732
US

IV. Provider business mailing address

3405 W NOB HILL BLVD UNIT A
YAKIMA WA
98902-4732
US

V. Phone/Fax

Practice location:
  • Phone: 509-317-6759
  • Fax: 509-420-9188
Mailing address:
  • Phone: 509-317-6759
  • Fax: 509-420-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWI.LW.61644597
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.61644597
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: