Provider Demographics
NPI:1225365083
Name:THIBAULT, TRISTAN ELIZABETH (MFT)
Entity Type:Individual
Prefix:MRS
First Name:TRISTAN
Middle Name:ELIZABETH
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 E WARM SPRINGS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3134
Mailing Address - Country:US
Mailing Address - Phone:702-813-6226
Mailing Address - Fax:
Practice Address - Street 1:3127 E WARM SPRINGS RD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3134
Practice Address - Country:US
Practice Address - Phone:702-813-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist