| Bryan L Bolwahnn, PHD, MP | |
|
100 Gayven Dr, Ball, LA 71405-4903 | |
| (318) 641-0444 | |
| (318) 641-6118 |
| Full Name | Bryan L Bolwahnn |
|---|---|
| Gender | Male |
| Speciality | Clinical Psychologist |
| Experience | 25 Years |
| Location | 100 Gayven Dr, Ball, Louisiana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043247331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 926MPAP (Louisiana) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Administrators Of The Tulane Educational Fund | 0446163760 | 370 |
| Rapides Primary Health Care Center, Incorporated | 3779570973 | 5 |
| Central La Human Services District | 7618105529 | 21 |
| Entity Name | Administrators Of The Tulane Educational Fund |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245434224 PECOS PAC ID: 0446163760 Enrollment ID: O20040114000146 |
| Entity Name | Rapides Primary Health Care Center, Incorporated |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568404838 PECOS PAC ID: 3779570973 Enrollment ID: O20040429001196 |
| Entity Name | Central La Human Services District |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033543756 PECOS PAC ID: 7618105529 Enrollment ID: O20140122000223 |
| Entity Name | Bayou Mental Health Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1518306000 PECOS PAC ID: 8123446887 Enrollment ID: O20201005001450 |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan L Bolwahnn, PHD, MP 100 Gayven Dr, Ball, LA 71405-4903 Ph: (318) 641-0444 | Bryan L Bolwahnn, PHD, MP 100 Gayven Dr, Ball, LA 71405-4903 Ph: (318) 641-0444 |
Richard L Wakefield, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 5529 Monroe Hwy, Ball, LA 71405 Phone: 318-641-0444 |