Individual
BRYAN L BOLWAHNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, M.P.
Contact information
Practice address
100 GAYVEN DR, BALL, LA 71405-4903
(318) 641-0444
(318) 641-6118
Mailing address
100 GAYVEN DR, BALL, LA 71405-4903
(318) 641-0444
(318) 641-6118
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
926MPAP
LA
Other
Enumeration date
06/26/2006
Last updated
10/09/2013
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