Individual
BRADFORD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TLLP
Contact information
Practice address
5675 FAIRVIEW ST, STEVENSVILLE, MI 49127-1033
(269) 429-7727
(269) 429-5754
Mailing address
5675 FAIRVIEW ST, STEVENSVILLE, MI 49127-1033
(269) 429-7727
(269) 429-5754
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6301015339
MI
101Y00000X
Counselor
6361007564
MI
103T00000X
Psychologist
Primary
6361007564
MI
Other
Enumeration date
12/18/2012
Last updated
02/10/2025
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