Boisey J Bristo Sr., LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

75700 Issued in TX

Practice address

6161 Amelia Ave.
1315
Fort Worth, TX 76123-2141

Phone

(484) 544-9198

NPI assigned

May 15, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  TX

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1225528284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6161 AMELIA AVE.",
            "address_2": "1315",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232141",
            "telephone_number": "484-544-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 AMELIA AVE.",
            "address_2": "1315",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232141",
            "telephone_number": "484-544-9198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTO",
        "first_name": "BOISEY",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-15",
        "last_updated": "2023-08-18",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "75700",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "75700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Briscoe, MD
• Isaac Briseno-Diaz
• Alejandra Ochoa Briseno, LCSW
• Jason Lamont Brister, LCDC
• Katriana Fields Brister, MS, GC
• Nancy Jane Bristow, RN, BSN, CDE
• Brit D Phillips DDS PA
• Isabel De Rosas Britain, DDS
• Steven Keith Britain, DDS
• Lisa Brite

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.