Provider Demographics
NPI:1003348483
Name:FOX, TRISTAN A (BACHELORS)
Entity Type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:A
Last Name:FOX
Suffix:
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69239 HILLY RD.
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444
Mailing Address - Country:US
Mailing Address - Phone:985-415-5135
Mailing Address - Fax:
Practice Address - Street 1:560 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-652-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health