Ronald Ray Bristow, LCPC, MS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.009189 Issued in IL

Practice address

888 E Belvidere Rd
Suite 319
Grayslake, IL 60030-2568

Phone

(847) 924-0261

NPI assigned

Jun 17, 2014

Sex

Male

Sole proprietor

Yes

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.

• Onward Counseling Center

  • Professional Counselor
  • Grayslake, IL
  • NPI 1992239396

  Professional

  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 12, 2017.

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1962816967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 E BELVIDERE RD",
            "address_2": "SUITE 319",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302568",
            "telephone_number": "847-924-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 E BELVIDERE RD",
            "address_2": "SUITE 319",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302568",
            "telephone_number": "847-924-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOW",
        "first_name": "RONALD",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "LCPC, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-17",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.009189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Grayslake, IL
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.