Provider Demographics
NPI:1790445021
Name:TRISTATE COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:TRISTATE COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:319-330-1082
Mailing Address - Street 1:15320 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-7103
Mailing Address - Country:US
Mailing Address - Phone:319-330-1082
Mailing Address - Fax:
Practice Address - Street 1:15320 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-7103
Practice Address - Country:US
Practice Address - Phone:319-330-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty