Provider Demographics
NPI:1255898441
Name:KUBAT, BRADLEY (MHC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:KUBAT
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 N ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5644
Mailing Address - Country:US
Mailing Address - Phone:253-617-8857
Mailing Address - Fax:
Practice Address - Street 1:3917 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-9920
Practice Address - Country:US
Practice Address - Phone:509-822-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0000101YM0800X
WA61195059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0000Medicaid