MEDICARE: KURT BRADFORD SMITH CADC II, CRM, QMHA I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	16-CRM-084	OR
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	18-09-40	OR
3	101YM0800X	Mental Health Counselor	19-QMHA-I-00673	OR

General Provider Information

NPI Number	:	1356841076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT BRADFORD SMITH CADC II, CRM, QMHA I

Provider Business Mailing Address
First Line	:	1942 SHERIDAN AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-3416
Country	:	US
Telephone Number	:	541-435-1152
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 SHERMAN AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2872
Country	:	US
Telephone Number	:	541-217-5239
Fax Number	:	541-808-3134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	05/22/2026

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