Doctor Name: | MRS. BRANDYLYN S BRISTOW |
NPI Number: | 1154630770 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 20080000932 |
Business Practice Address: | 708 East Highway 28 Owensville, MO - 65066 |
Business Phone Number: | 5734861193 |
Business Fax Number: | 5734860910 |
Mailing Address: | 2591 Fowler Road, HERMANN |
State: | MO |
Postal Code: | 65041 |
Phone Number: | 5739439973 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2010 |
NPI Last Update Date: | 02/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 20080000932 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |