Provider Demographics
NPI:1962067652
Name:BRADLEY, REBECCA R (LCPC, LMFT,LMHC, NCC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCPC, LMFT,LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W IRONWOOD DR STE 330
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:208-274-3020
Mailing Address - Fax:208-561-7081
Practice Address - Street 1:1250 W IRONWOOD DR STE 330
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:208-274-3020
Practice Address - Fax:208-561-7081
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
IDLCPC-9186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health