Provider Demographics
NPI:1831524651
Name:PEREZ CRAWFORD, TRISTA ALESE (PHD)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:ALESE
Last Name:PEREZ CRAWFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:ALESE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:35 JESSE HILL JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3032
Mailing Address - Country:US
Mailing Address - Phone:404-785-9500
Mailing Address - Fax:
Practice Address - Street 1:35 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3032
Practice Address - Country:US
Practice Address - Phone:404-785-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006408103TC0700X, 103TC2200X
KS2193103TC2200X
GA004691103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical