Provider Demographics
NPI:1326542432
Name:BRISTOW, DAVID (BCBA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRISTOW
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2948
Mailing Address - Country:US
Mailing Address - Phone:406-443-3083
Mailing Address - Fax:
Practice Address - Street 1:1236 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2948
Practice Address - Country:US
Practice Address - Phone:406-443-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1-13-13808OtherBCBA CERIFICATE NUMBER