Provider Demographics
NPI:1588234264
Name:BRISTOW, CARIE LAVELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:LAVELLE
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4813
Mailing Address - Country:US
Mailing Address - Phone:805-205-0231
Mailing Address - Fax:
Practice Address - Street 1:3240 STRATHMORE DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4813
Practice Address - Country:US
Practice Address - Phone:805-205-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty