Individual
DR. JOHN BRADLEY CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
31500 W 13 MILE RD, #111, FARMINGTON HILLS, MI 48334-2164
(248) 855-9220
(248) 855-3866
Mailing address
PO BOX 2689, 2311 E. STADIUM BLVD, ANN ARBOR, MI 48106-2689
(734) 761-9835
(248) 855-3866
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
6301007077
MI
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68-0-F3-3086-0
BCBS OF MICHIGAN
MI
Enumeration date
01/30/2009
Last updated
01/30/2009
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