| NPI | 1770687717 |
|---|---|
| Other Name | BRAD WAYNE LORD |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH8489) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL CAP 2585) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2022-11-23 |