Provider Demographics
NPI:1497065155
Name:VONADA, TRISTA ELAINE
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:ELAINE
Last Name:VONADA
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 1:3455 BIRKLAND DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-9196
Mailing Address - Country:US
Mailing Address - Phone:406-951-2693
Mailing Address - Fax:
Practice Address - Street 1:1900 N LAST CHANCE GULCH STE 9
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0798
Practice Address - Country:US
Practice Address - Phone:406-951-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MT55131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker