Provider Demographics
NPI:1992529549
Name:CORY, TRISTA LIANE (BS)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:LIANE
Last Name:CORY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TRISTA
Other - Middle Name:LIANE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:547 WOODVALE AVE REAR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1332
Mailing Address - Country:US
Mailing Address - Phone:814-418-1579
Mailing Address - Fax:
Practice Address - Street 1:429 MANOR DR STE 10
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-472-6060
Practice Address - Fax:814-472-1293
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker