Individual
LARRY MILES BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
335 E MAIN ST STE 1, SAINT ANTHONY, ID 83445-1546
(208) 356-4900
(208) 624-4030
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4112
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 30350
ID
Other
Enumeration date
04/25/2013
Last updated
06/03/2024
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