Provider Demographics
NPI:1437446945
Name:CARR, TRISTA LINN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:LINN
Last Name:CARR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460463
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94146-0463
Mailing Address - Country:US
Mailing Address - Phone:415-494-9313
Mailing Address - Fax:415-520-6634
Practice Address - Street 1:406 CORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5538
Practice Address - Country:US
Practice Address - Phone:415-494-9313
Practice Address - Fax:415-520-6634
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04849103TC0700X
CAPSY25232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical