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General NPI Number Information
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NPI Number | 1053513374
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Entity Type | Individual
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Provider Name | PATRICIA A BRISTOW LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 607 MCCULLOUGH AVE NE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6342
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Country | US
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Telephone | 256-655-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 105 TAHOE CIR
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City | HARVEST
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State | AL
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Zip | 35749-9628
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Country | US
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Telephone | 256-655-7577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1862C
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License Number State | AL
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