Provider Demographics
NPI:1427372846
Name:SMITH, BRADLEY GEOFF (CMHC, NCC, R-DMT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:GEOFF
Last Name:SMITH
Suffix:
Gender:M
Credentials:CMHC, NCC, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 N 1200 E STE 110
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2247
Mailing Address - Country:US
Mailing Address - Phone:385-287-0555
Mailing Address - Fax:386-287-0555
Practice Address - Street 1:149 N 1200 E STE 110
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2247
Practice Address - Country:US
Practice Address - Phone:385-287-0555
Practice Address - Fax:385-287-0555
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9087936-6004101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health