Provider Demographics
NPI:1740557883
Name:ADAMS, TRISTA NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:NICOLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 BOX ELDER DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-3414
Mailing Address - Country:US
Mailing Address - Phone:173-166-8759
Mailing Address - Fax:173-166-0751
Practice Address - Street 1:60 LYNOAK CV
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2909
Practice Address - Country:US
Practice Address - Phone:731-668-7593
Practice Address - Fax:731-660-7512
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor