Tristan Garrett, LICDC | |
5815 Westbourne Ave, Columbus, OH 43213-1459 | |
(833) 510-4357 | |
Not Available |
Full Name | Tristan Garrett |
---|---|
Gender | Male |
Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 5815 Westbourne Ave, Columbus, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1114437696 | NPI | - | NPPES |
0286965 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | LICDC.162286 (Ohio) | Primary |
Entity Name | Cleanslate Medical Group Of Ohio Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1558800193 PECOS PAC ID: 9537418025 Enrollment ID: O20190108003833 |
Mailing Address | Practice Location Address |
---|---|
Tristan Garrett, LICDC 4600 Montgomery Rd Ste 400, Cincinnati, OH 45212-2600 Ph: (833) 510-4357 | Tristan Garrett, LICDC 5815 Westbourne Ave, Columbus, OH 43213-1459 Ph: (833) 510-4357 |
Mr. Daryush Parvinbenam, PCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 287 W Johnstown Rd, Columbus, OH 43230 Phone: 614-305-5102 Fax: 614-383-7786 | |
Molly Marie Fields, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1115 Bethel Rd, Columbus, OH 43220 Phone: 614-459-9022 Fax: 614-451-3017 | |
Mr. Lucas Alan Hawkins, Counselor Medicare: Not Enrolled in Medicare Practice Location: 444 Butterfly Gardens Dr, Columbus, OH 43215 Phone: 614-938-0350 Fax: 614-938-0170 | |
Ms. Katherine Anne Risinger, LPCC-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 444 Butterfly Gardens Dr, Columbus, OH 43215 Phone: 614-355-8550 Fax: 614-355-8593 | |
Tracie Lynn Keller, LPCC-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 1080 Fishinger Rd, Suite 103, Columbus, OH 43221 Phone: 614-822-7819 Fax: 614-372-5590 | |
Jennifer R Williams, PCC-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 1301 N High St, Columbus, OH 43201 Phone: 614-227-6865 Fax: 614-227-6873 | |
Heather Russo, Counselor Medicare: Not Enrolled in Medicare Practice Location: 444 Butterfly Gardens Dr, Columbus, OH 43215 Phone: 614-355-8695 Fax: 614-355-7855 |