Bristol Youth Academy | |
12422 Nw G T Revell Rd Bristol FL 32321-3007 | |
(850) 643-4600 | |
(850) 643-2061 |
Full Name | Bristol Youth Academy |
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Speciality | Counselor |
Location | 12422 Nw G T Revell Rd, Bristol, Florida |
Authorized Official Name and Position | Jeanette Jackson (PROGRAM DIRECTOR) |
Authorized Official Contact | 8506434600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Bristol Youth Academy 12422 Nw G T Revell Rd Bristol FL 32321-3007 Ph: (850) 643-4600 | Bristol Youth Academy 12422 Nw G T Revell Rd Bristol FL 32321-3007 Ph: (850) 643-4600 |
NPI Number | 1134309438 |
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Provider Enumeration Date | 11/05/2007 |
Last Update Date | 06/14/2008 |
Identifier | Type | State | Issuer |
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1134309438 | NPI | - | NPPES |
0239AD272501 | Other | FL | OUTPATIENT SUBSTANCE ABUS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101Y00000X | Counselor | (* (Not Available)) | Primary |
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