Individual
BRADLEY S WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
1145 VOLUNTEER PKWY, BRISTOL, TN 37620-4652
(423) 989-4500
(423) 989-4582
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1777
TN
Other
Enumeration date
12/28/2023
Last updated
03/04/2025
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