Provider Demographics
NPI:1568519494
Name:TRYTTEN, EMILY WIST (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:WIST
Last Name:TRYTTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER PT
Mailing Address - Street 2:#253
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8732
Mailing Address - Country:US
Mailing Address - Phone:719-634-1825
Mailing Address - Fax:719-634-1874
Practice Address - Street 1:1633 MEDICAL CENTER PT
Practice Address - Street 2:#253
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8732
Practice Address - Country:US
Practice Address - Phone:719-634-1825
Practice Address - Fax:719-634-1874
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9919951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical