Individual
JOLENE BRISTOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LPC
Contact information
Practice address
701 N. LA CANADA DRIVE, SUITE 90, GREEN VALLEY, AZ 85614
(520) 625-3835
(520) 625-5585
Mailing address
218 W PINON DR, GREEN VALLEY, AZ 85614-4332
(520) 370-2363
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 12398
AZ
Other
Enumeration date
10/20/2006
Last updated
06/22/2010
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