| 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 |
|---|---|
| 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, LPCC-S 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, LPCC-S Counselor Medicare: Not Enrolled in Medicare Practice Location: 444 Butterfly Gardens Dr, Columbus, OH 43215 Phone: 614-355-8695 Fax: 614-355-7855 |