| Bristol Youth Academy | |
|
12422 Nw G T Revell Rd Bristol FL 32321-3007 | |
| (850) 643-4600 | |
| (850) 643-2061 |
| Full Name | Bristol Youth Academy |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 11/05/2007 |
| Last Update Date | 06/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134309438 | NPI | - | NPPES |
| 0239AD272501 | Other | FL | OUTPATIENT SUBSTANCE ABUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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