MEDICARE: BRISTLECONE COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588373468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISTLECONE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	5837 DE ZAVALA RD.
Second Line	:	P. O. BOX 690102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249
Country	:	US
Telephone Number	:	361-861-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BALCONES DR STE 7402
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	208-874-7036
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH & ADDICTION COUNSELOR
Name	:	DR. JORDAN ELLIOTT
Credential	:	LPC, LCDC
Telephone Number	:	361-861-5155

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	12/05/2022

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