Individual
BRADLEY JOLINE ANTONIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(337) 531-6140
Mailing address
1585 3RD ST, FORT POLK, LA 71459-5102
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY60633804
WA
Other
Enumeration date
08/04/2013
Last updated
02/21/2017
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