MEDICARE: MR. BRADLEY SMITH PCCI

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	101YM0800X	Mental Health Counselor	PCCI12756	CA

General Provider Information

NPI Number	:	1821449000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY SMITH PCCI

Provider Business Mailing Address
First Line	:	8420 FORDHAM RD
Second Line	:	APT 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2581
Country	:	US
Telephone Number	:	310-704-3482
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 FORDHAM RD
Second Line	:	APT 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2581
Country	:	US
Telephone Number	:	310-704-3482
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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