Provider Demographics
NPI:1295403442
Name:PRISTINE ADVANCEMENTS LLC
Entity Type:Organization
Organization Name:PRISTINE ADVANCEMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-754-4342
Mailing Address - Street 1:594 SAWDUST RD STE 153
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2215
Mailing Address - Country:US
Mailing Address - Phone:832-754-4342
Mailing Address - Fax:
Practice Address - Street 1:425 MCCALEB RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-5219
Practice Address - Country:US
Practice Address - Phone:832-797-8451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty