Provider Demographics
NPI:1770936619
Name:WINSTON, TRISTEN DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRISTEN
Middle Name:DIANE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S CLAIRBORNE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1774
Mailing Address - Country:US
Mailing Address - Phone:913-648-2266
Mailing Address - Fax:913-768-1944
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:855-348-3430
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCAC702101YA0400X
CA28438103TC0700X
KS2487103TC0700X
MO2021027885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201218600AMedicaid