Individual
MR. BRADLY SCOTT MCCOLLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5975
Mailing address
190 DONNA LN, STONEWALL, LA 71078-9662
(318) 918-0958
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9212
LA
Other
Enumeration date
05/19/2023
Last updated
04/22/2024
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