Provider Demographics
NPI:1477370096
Name:TRISTAN, CANDIDA CONSUELO (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:CONSUELO
Last Name:TRISTAN
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:CANDI
Other - Middle Name:
Other - Last Name:TRISTAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:122 POTRANCO ROAD
Mailing Address - Street 2:486
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-970-2126
Mailing Address - Fax:
Practice Address - Street 1:8231 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3356
Practice Address - Country:US
Practice Address - Phone:219-767-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health