Provider Demographics
NPI:1083470447
Name:STEWART, TRISTAN (PLPC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17534 OLD JEFFERSON HWY STE B2
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3978
Mailing Address - Country:US
Mailing Address - Phone:225-244-9110
Mailing Address - Fax:504-335-0775
Practice Address - Street 1:17534 OLD JEFFERSON HWY STE B2
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3978
Practice Address - Country:US
Practice Address - Phone:225-244-9110
Practice Address - Fax:504-335-0775
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional