Provider Demographics
NPI:1467579227
Name:VANCE, TRISTEN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:TRISTEN
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FLYNN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8737
Mailing Address - Country:US
Mailing Address - Phone:805-218-7767
Mailing Address - Fax:805-618-2898
Practice Address - Street 1:1100 FLYNN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8737
Practice Address - Country:US
Practice Address - Phone:805-218-7767
Practice Address - Fax:805-618-2898
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49417106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist