Provider Demographics
NPI:1588232037
Name:ASAY GORDER, TRISTEN M
Entity Type:Individual
Prefix:
First Name:TRISTEN
Middle Name:M
Last Name:ASAY GORDER
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 1:1809 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5751
Mailing Address - Country:US
Mailing Address - Phone:907-980-7713
Mailing Address - Fax:
Practice Address - Street 1:1809 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5751
Practice Address - Country:US
Practice Address - Phone:907-980-7713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor