Bryan L Bolwahnn, PhD, M.P.
Psychologist, Prescribing (Medical) in Ball, LA. Individual provider (NPI-1).
NPI number1043247331
StatusActive
Last updated in NPPESOct 9, 2013
Details
- NPI
- 1043247331
- Entity type
- Individual (NPI-1)
- Name
- Bryan L Bolwahnn
- Credential
- PhD, M.P.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 26, 2006
- Last updated
- Oct 9, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TP0016X | Psychologist, Prescribing (Medical) | 926MPAP | LA | Yes |
Practice location
100 Gayven DrBall, LA 71405-4903
Phone 318-641-0444 · Fax 318-641-6118
Mailing address
100 Gayven DrBall, LA 71405-4903
Phone 318-641-0444 · Fax 318-641-6118
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