Provider Demographics
NPI:1265566996
Name:CASEY, TRISTANA NICOLE (MFT MFC 44348)
Entity type:Individual
Prefix:MRS
First Name:TRISTANA
Middle Name:NICOLE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MFT MFC 44348
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 PARK PLAZA DRIVE
Mailing Address - Street 2:#101
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-697-0476
Mailing Address - Fax:619-697-0505
Practice Address - Street 1:9029 PARK PLAZA DRIVE
Practice Address - Street 2:#101
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-697-0476
Practice Address - Fax:619-697-0505
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 44348OtherBBS