Provider Demographics
NPI:1225899149
Name:MORAN, TRISTAN BRYCE (RBT)
Entity Type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:BRYCE
Last Name:MORAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 N 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7707
Mailing Address - Country:US
Mailing Address - Phone:623-776-5209
Mailing Address - Fax:
Practice Address - Street 1:8823 N 94TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7707
Practice Address - Country:US
Practice Address - Phone:623-776-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-23-297486106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician