Provider Demographics
NPI:1457934036
Name:BARRY, TRISTINE E (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:TRISTINE
Middle Name:E
Last Name:BARRY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 WHITE PINE CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6672
Mailing Address - Country:US
Mailing Address - Phone:727-224-8250
Mailing Address - Fax:
Practice Address - Street 1:3636 GALILEO DR STE 101-102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1809
Practice Address - Country:US
Practice Address - Phone:727-261-0508
Practice Address - Fax:727-616-4707
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health