Individual
MR. BRADLEY ROSS RABURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC - IDAHO
Contact information
Practice address
6 TERRACE DR, GARDEN VALLEY, ID 83622-5272
(208) 972-3237
Mailing address
6 TERRACE DR, GARDEN VALLEY, ID 83622-5272
(208) 972-3237
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C6001
OR
101Y00000X
Counselor
LCPC-6488
ID
101YM0800X
Mental Health Counselor
C6001
OR
101YM0800X
Mental Health Counselor
LCPC-6488
ID
101YP2500X
Professional Counselor
C6001
OR
101YP2500X
Professional Counselor
Primary
LCPC-6488
ID
Other
Enumeration date
02/09/2017
Last updated
04/15/2026
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