Provider Demographics
NPI:1619409521
Name:HEMENWAY, TRISTA (LIMHP, CMSW)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:HEMENWAY
Suffix:
Gender:F
Credentials:LIMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 NEWPORT AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2167
Mailing Address - Country:US
Mailing Address - Phone:402-572-3490
Mailing Address - Fax:
Practice Address - Street 1:7101 NEWPORT AVE STE 304
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2167
Practice Address - Country:US
Practice Address - Phone:402-572-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1853104100000X
NE3109101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker