Provider Demographics
NPI:1922506617
Name:CHARNAS, TRISTA LEE
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:LEE
Last Name:CHARNAS
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 1:1436 S NEWPORT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2018
Mailing Address - Country:US
Mailing Address - Phone:219-929-8076
Mailing Address - Fax:
Practice Address - Street 1:1436 S NEWPORT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2018
Practice Address - Country:US
Practice Address - Phone:219-929-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health