Provider Demographics
NPI:1346010410
Name:MORGAN, TRISTAN R
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:R
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 ABERDEEN AVE NE APT C106, RENTON WA 98056
Mailing Address - Street 2:C 106
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056
Mailing Address - Country:US
Mailing Address - Phone:425-614-8339
Mailing Address - Fax:
Practice Address - Street 1:975 ABERDEEN AVE NE APT C106
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2861
Practice Address - Country:US
Practice Address - Phone:142-561-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician