Provider Demographics
NPI:1356841076
Name:SMITH, KURT BRADFORD (CADC II, CRM, QMHA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:BRADFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:CADC II, CRM, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3416
Mailing Address - Country:US
Mailing Address - Phone:541-435-1152
Mailing Address - Fax:
Practice Address - Street 1:155 S EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3374
Practice Address - Country:US
Practice Address - Phone:541-435-1152
Practice Address - Fax:541-756-2111
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-QMHA-I-00673101YM0800X
OR16-CRM-084175T00000X
OR18-09-40101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist