Provider Demographics
NPI:1144599556
Name:BRISTLE, ANNA RICHELLE (MS, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:RICHELLE
Last Name:BRISTLE
Suffix:
Gender:F
Credentials:MS, LLPC
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:RICHELLE
Other - Last Name:OLMSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 ARNET ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5706
Mailing Address - Country:US
Mailing Address - Phone:734-961-1990
Mailing Address - Fax:734-961-1996
Practice Address - Street 1:103 ARNET ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5706
Practice Address - Country:US
Practice Address - Phone:734-961-1990
Practice Address - Fax:734-961-1996
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012788101Y00000X
MI6803085177171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator