Individual
MARK BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1585 3RD ST, BJACH, FORT POLK, LA 71459-5102
(337) 531-3942
Mailing address
1585 3RD ST, BJACH, FORT POLK, LA 71459-5102
(337) 531-3942
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
02212
TX
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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