Doctor Name: | JOLENE BRISTOW |
NPI Number: | 1316029952 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, LPC |
License Number: | LPC 12398 |
Business Practice Address: | 701 N. La Canada Drive Suite 90 Green Valley, AZ - 85614 |
Business Phone Number: | 5206253835 |
Business Fax Number: | 5206255585 |
Mailing Address: | 218 W Pinon Dr, GREEN VALLEY |
State: | AZ |
Postal Code: | 856144332 |
Phone Number: | 5203702363 |
Fax Number: | |
NPI Enumeration Date: | 10/20/2006 |
NPI Last Update Date: | 06/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC 12398 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |