Provider Demographics
NPI:1124451075
Name:TRISTAN, MARIA OLINKA (LPC INTERN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:OLINKA
Last Name:TRISTAN
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BUSBY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1116
Mailing Address - Country:US
Mailing Address - Phone:210-826-7447
Mailing Address - Fax:
Practice Address - Street 1:515 BUSBY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1116
Practice Address - Country:US
Practice Address - Phone:210-826-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71169101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor