Provider Demographics
NPI:1689924540
Name:HOULE, BRADLEY LEE (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:LEE
Last Name:HOULE
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2547
Mailing Address - Country:US
Mailing Address - Phone:231-881-0288
Mailing Address - Fax:
Practice Address - Street 1:213 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2547
Practice Address - Country:US
Practice Address - Phone:231-881-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093579104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker