Provider Demographics
NPI:1023449501
Name:BALISTRIRE, NATHALYE CAROLINA (LPC)
Entity type:Individual
Prefix:
First Name:NATHALYE
Middle Name:CAROLINA
Last Name:BALISTRIRE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 N EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5127
Mailing Address - Country:US
Mailing Address - Phone:970-424-4061
Mailing Address - Fax:
Practice Address - Street 1:2204 N EMERSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5127
Practice Address - Country:US
Practice Address - Phone:970-424-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLPC.0014010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health