Provider Demographics
NPI:1346928819
Name:DIBELLA, TRISTYN LEE NOELL (LPC)
Entity Type:Individual
Prefix:
First Name:TRISTYN
Middle Name:LEE NOELL
Last Name:DIBELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRISTYN
Other - Middle Name:LEE NOELL
Other - Last Name:LUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1616 MISTLETOE BLVD APT 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4047
Mailing Address - Country:US
Mailing Address - Phone:817-682-8792
Mailing Address - Fax:
Practice Address - Street 1:1616 MISTLETOE BLVD APT 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4047
Practice Address - Country:US
Practice Address - Phone:817-682-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty