Provider Demographics
NPI:1114398765
Name:SMELCER, BRADLEY DEAN (OWNER)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DEAN
Last Name:SMELCER
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9533
Mailing Address - Country:US
Mailing Address - Phone:208-365-3183
Mailing Address - Fax:208-365-4205
Practice Address - Street 1:2328 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9533
Practice Address - Country:US
Practice Address - Phone:208-365-3183
Practice Address - Fax:208-365-4205
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker