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General NPI Number Information
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NPI Number | 1356726145
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Entity Type | Individual
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Provider Name | BRAD RICHARD SMEDLEY LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 5920 N GOVERNMENT WAY STE 4
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City | DALTON GARDENS
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State | ID
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Zip | 83815-9200
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Country | US
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Telephone | 509-989-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 3675 N SCOTCH PINE LN APT 3
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City | COEUR D ALENE
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State | ID
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Zip | 83815-1899
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Country | US
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Telephone | 509-989-4935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LF60804635
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMFT-7872
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-7872
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License Number State | ID
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