Healthcare Provider Details

I. General information

NPI: 1457952756
Provider Name (Legal Business Name): KRISTIN O. TRISTAO, PH.D., PSYCHOLOGIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N 1ST ST STE 138
FRESNO CA
93710-3956
US

IV. Provider business mailing address

6700 N 1ST ST STE 138
FRESNO CA
93710-3956
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-1977
  • Fax:
Mailing address:
  • Phone: 559-227-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN TRISTAO
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 559-227-1977