Provider Demographics
NPI:1184898116
Name:MEAD-RODRIGUES, TRISTIN NOELLE (LPC)
Entity type:Individual
Prefix:MS
First Name:TRISTIN
Middle Name:NOELLE
Last Name:MEAD-RODRIGUES
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 1:2640 W. 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211
Mailing Address - Country:US
Mailing Address - Phone:720-280-4368
Mailing Address - Fax:303-957-5953
Practice Address - Street 1:2640 W. 28TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211
Practice Address - Country:US
Practice Address - Phone:720-280-4368
Practice Address - Fax:303-957-5953
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2974101YP2500X, 101Y00000X
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133N00000XDietary & Nutritional Service ProvidersNutritionist