Provider Demographics
NPI:1336227446
Name:PRISTASH, CHRISTINA LYNN (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LYNN
Last Name:PRISTASH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 BUSH CT SW
Mailing Address - Street 2:
Mailing Address - City:EYOTA
Mailing Address - State:MN
Mailing Address - Zip Code:55934-3106
Mailing Address - Country:US
Mailing Address - Phone:507-202-0701
Mailing Address - Fax:
Practice Address - Street 1:1700 N BROADWAY STE 118
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4144
Practice Address - Country:US
Practice Address - Phone:507-202-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist