Provider Demographics
NPI:1669549838
Name:CARISTA, JANET G (MA)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:G
Last Name:CARISTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 N 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2054
Mailing Address - Country:US
Mailing Address - Phone:602-841-0860
Mailing Address - Fax:602-841-0902
Practice Address - Street 1:6130 N 18TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2054
Practice Address - Country:US
Practice Address - Phone:602-841-0860
Practice Address - Fax:602-841-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional