Provider Demographics
NPI:1013347988
Name:HOLINSWORTH, BRADFORD DON
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:DON
Last Name:HOLINSWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 S CHEROKEE PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-3538
Mailing Address - Country:US
Mailing Address - Phone:918-955-9772
Mailing Address - Fax:
Practice Address - Street 1:2009 S CHEROKEE PL
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-3538
Practice Address - Country:US
Practice Address - Phone:918-955-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)