Healthcare Provider Details

I. General information

NPI: 1821587650
Provider Name (Legal Business Name): MIGUEL ANGEL TRISTE JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

IV. Provider business mailing address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

V. Phone/Fax

Practice location:
  • Phone: 970-347-2120
  • Fax:
Mailing address:
  • Phone: 970-347-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023274
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: