KEYSTONE DJJ, LLC (NPI# 1134309438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134309438 |
| Entity Type | Organization |
| Organization Name | KEYSTONE DJJ, LLC |
| Other Organization Name | BRISTOL YOUTH ACADEMY |
| Practice Address |
12422 Nw G T Revell Rd Bristol FL 32321-3007 |
| Practice Telephone | 8506434600 |
| Practice Fax Number | 8506432061 |
| Mailing Telephone | 8506434600 |
| Mailing Fax Number | 8506432061 |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2008-06-14 |
| Authorized Official Name | MRS. JEANETTE JACKSON (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 8506434600 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | OUTPATIENT SUBSTANCE ABUS | 0239AD272501 | 01 |
| Other Name | Type Code |
|---|---|
| Bristol Youth Academy | Other Name - Individual/Organization |
| Street Address |
12422 NW G T REVELL RD |
| City | BRISTOL |
| State | FL |
| Zip Code | 32321-3007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124357264 | Kathryn Grace Strickland | Counselor | 12422 Nw G T Revell Rd, Bristol, FL 32321-3007 | 2009-12-21 |
| 1407019797 | Jeanette Jackson | Social Worker | 12422 Nw G T Revell Rd, Bristol, FL 32321-3007 | 2008-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649739194 | Amberly Portero | Counselor | 10611 Florida Highway 20, Bristol, FL 32321 | 2019-03-14 |
| 1194281121 | Ash Bailey Smith | Social Worker | 10659 Nw Sr 20, Bristol, FL 32321 | 2019-02-14 |
| 1508295692 | Maggie Chavez | Counselor | 12422 Ne Revell Road, Bristol, FL 32321 | 2013-11-08 |
| 1437586609 | Queen Brown Haven Assisted Living Facility | Assisted Living Facility | 6906 Nw Torreya Park Road, Bristol, FL 32321 | 2013-10-03 |
| 1538400072 | Ruby Lee Varnum | Assisted Living Facility | 12167 Nw Freeman Rd, Bristol, FL 32321 | 2013-03-08 |
| 1417233321 | April Dawn Landrum | Case Management | 13888 Nw Cr 12, Apalachee Center, Inc., Bristol, FL 32321 | 2011-10-25 |
| 1417191107 | Elizabeth Stephanie Hofrichter | Social Worker | 11033 Nw Sr 20, Bristol, FL 32321 | 2009-04-24 |
| 1275734881 | Efren L Baltazar | Obstetrics & Gynecology | 2571 Executive Center Circle East, Howard Building Division of Disability Determination, Tallahassee, FL 32321 | 2007-05-30 |
| 1336260322 | Laban Bontrager | Dentist | 12761 Ne Pea Ridge Rd, Bristol, FL 32321 | 2007-04-03 |
| 1225192404 | Liberty County School Board | Local Education Agency (LEA) | 12926 Nw Cr 12, Bristol, FL 32321 | 2006-12-21 |
| Find all providers in zip 32321 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679109219 | Jessica Spar | Counselor | 40 Sand Hill Rd, Bristol, CT 06010-2932 | 2020-03-16 |
| 1043661481 | Edmond Mekie Rambal | Counselor | 1405 Veterans Hwy Apt G6, Bristol, PA 19007-2319 | 2016-06-27 |
| 1376961607 | Claudia Deforest | Counselor | 5 Shore Rd, Bristol, RI 02809-1325 | 2014-04-03 |
| 1922362276 | Megan R Loving | Counselor | 402 Bluff City Hwy, Apt 313, Bristol, TN 37620-4612 | 2012-07-02 |
| 1114236775 | Melissa Ann Ortiz | Counselor | 62 Mills St, Bristol, CT 06010-4940 | 2010-09-30 |
| 1265694517 | Hilary Musgrove | Counselor | 628 Rose St, Bristol, TN 37620-2328 | 2008-06-27 |
| 1811025026 | Ronald N. Mancini and Associates | Counselor | 970 Hope St Unit 5, Bristol, RI 02809-5210 | 2007-03-01 |
| 1669570164 | Maureen Ann Consiglio | Counselor | 188 Melinda Ln, Bristol, CT 06010 | 2006-09-20 |
| 1669578886 | Holston Um Home for Children | Counselor | 300 Moore St Ste A, Bristol, VA 24201-4337 | 2006-09-15 |
| 1518988666 | Joanne Thuesen St.john | Counselor | 220 Airport Dr, Bristol, VT 05443-1235 | 2006-07-22 |
| Find all providers in BRISTOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.