Provider Demographics
NPI:1619680279
Name:WEDDING, TRYSTA N (LPCC)
Entity Type:Individual
Prefix:
First Name:TRYSTA
Middle Name:N
Last Name:WEDDING
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30049 LIGHTENING LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8748
Mailing Address - Country:US
Mailing Address - Phone:720-480-2689
Mailing Address - Fax:
Practice Address - Street 1:3470 S SHERMAN ST STE 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2663
Practice Address - Country:US
Practice Address - Phone:720-443-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health