Provider Demographics
NPI:1356814560
Name:SPAIN-AUSTIN, TRISHAYA
Entity Type:Individual
Prefix:
First Name:TRISHAYA
Middle Name:
Last Name:SPAIN-AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 GILMORE PARK AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3955
Mailing Address - Country:US
Mailing Address - Phone:614-598-0832
Mailing Address - Fax:
Practice Address - Street 1:545 METRO PLACE NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-598-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician