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Individual

MR. BRADLEY RAY BOLIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
BS

Contact information

Practice address
3100 S ELM PL STE B, BROKEN ARROW, OK 74012-7950
(918) 286-2535
(918) 286-7693
Mailing address
3100 S ELM PL STE B, BROKEN ARROW, OK 74012-7950
(918) 286-2535
(918) 286-7693

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
OK
101YM0800X
Mental Health Counselor

Other

Enumeration date
11/08/2010
Last updated
11/08/2010
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