Provider Demographics
NPI:1912513698
Name:BRISTOL, AUDREY (LCSW)
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2246
Mailing Address - Country:US
Mailing Address - Phone:214-986-4847
Mailing Address - Fax:
Practice Address - Street 1:1780 S BELLAIRE ST STE 485
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4326
Practice Address - Country:US
Practice Address - Phone:303-809-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099284271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical