Individual
KELCEE NIKOLE BRISTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(360) 642-3787
Mailing address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(360) 642-3787
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/09/2021
Last updated
08/11/2022
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