Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1013347988 |
---|---|
Provider Name | Bradford Don Holinsworth |
First Address | Claremore, OK 74019-3538 |
Second Address | Claremore, OK 74019-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 13/11/2013 |