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General NPI Number Information
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NPI Number | 1144599556
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Entity Type | Individual
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Provider Name | ANNA RICHELLE BRISTLE MS, LLPC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 103 ARNET ST
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City | YPSILANTI
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State | MI
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Zip | 48198-5706
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Country | US
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Telephone | 734-961-1990
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Fax | 734-961-1996
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Provider Business Mailing Address
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Address Line | 103 ARNET ST
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City | YPSILANTI
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State | MI
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Zip | 48198-5706
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Country | US
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Telephone | 734-961-1990
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Fax | 734-961-1996
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401012788
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 6803085177
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License Number State | MI
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