Provider Demographics
NPI:1407347313
Name:TYLER, TRISTA (BA, QMHA)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:BA, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 PORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6225
Mailing Address - Country:US
Mailing Address - Phone:503-704-0515
Mailing Address - Fax:
Practice Address - Street 1:445 PORT AVE STE A
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6225
Practice Address - Country:US
Practice Address - Phone:503-704-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator