Tyler William Bristow, BA

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

707 NE Couch St
Portland, OR 97232-2922

Phone

(503) 542-4610

Fax

(503) 233-6093

NPI assigned

Feb 7, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

Practice roles

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.

• Janus Youth Programs

  • Substance Abuse Rehabilitation Facility
  • Portland, OR
  • NPI 1912331646
  NPD (past)
• Janus Youth Programs, Inc.

  • Voluntary or Charitable Agency
  • Portland, OR
  • NPI 1003248642
  NPD (past)

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

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391731200000",
    "number": "1922422138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322922",
            "telephone_number": "503-542-4610",
            "fax_number": "503-233-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322922",
            "telephone_number": "503-542-4610",
            "fax_number": "503-233-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOW",
        "first_name": "TYLER",
        "middle_name": "WILLIAM",
        "credential": "BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-07",
        "last_updated": "2014-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TREATMENT PROGRAM",
            "identifier": "104100000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Brisko, LPCA
• John Thomas Bristol, CADC-I, CRM
• Kelly Bristol, RN
• Angela Bristow
• Daniel Joseph Bristow, M.D.
• John Palmer Brittan II, D.M.D.
• Brittany C. Tilton, LCSW, P.C.
• Brittany Russ' Clinical Social Work and Therapy Services LLC
• Brittany Russ' Clinical Social Work and Therapy Services LLC
• Annette Rachel Britton, CADC 1

• Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.