Provider Demographics
NPI:1235372780
Name:MARRIOTT, TRISTAN MARYAH (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TRISTAN
Middle Name:MARYAH
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MISS
Other - First Name:TRISTAN
Other - Middle Name:MARYAH
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:857 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2721
Mailing Address - Country:US
Mailing Address - Phone:305-526-0067
Mailing Address - Fax:
Practice Address - Street 1:857 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2721
Practice Address - Country:US
Practice Address - Phone:305-526-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-12906103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst