Rebecca R Bradley, LCPC, LMFT,LMHC, NCC
Individual provider Active NPI Marriage & Family Therapist · Coeur D Alene, ID
NPI 1962067652 · NPPES record last updated Oct 2, 2024
Key facts
- NPI
- 1962067652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- Practice address
- 1250 W Ironwood Dr Ste 330
Coeur D Alene, ID 83814-2682 - Phone
- (208) 274-3020
- Fax
- (208) 561-7081
- NPI assigned
- May 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-9186 | ID | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beachside Counseling LLC | Current |
Accepting new patients | |
| Children'S Home Society of Washington | Past | Accepting new patients |
Locations
1250 W Ironwood Dr
Ste 330
Coeur D Alene, ID 83814
Phone (208) 215-2202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Yes | ||
| Mental Health Counselor | 101YM0800X | LCPC-9186 | ID |
Addresses
Primary practice location
1250 W Ironwood Dr Ste 330
Coeur D Alene, ID 83814-2682
Mailing address
1250 W Ironwood Dr Ste 330
Coeur D Alene, ID 83814-2682
Phone (208) 274-3020
Other providers in Coeur D Alene, ID
- Daniel Boylan
- Catherine A Boysen
- Chandler Bozarth
- Nina Sienna Bozinov
- Heidi Rose Brackebusch
- Brittney C Brady
- Rena L Bradymire
- Michael L Brandt
- Michah Brasseur
- Jillienne Braucher Sells
All providers in Coeur D Alene, ID · Marriage & Family Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.