Provider Demographics
NPI:1023124336
Name:SOPHIA, TRISTAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TRISTAN
Middle Name:
Last Name:SOPHIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 S ARLINGTON 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:406-426-8168
Mailing Address - Fax:406-723-5406
Practice Address - Street 1:1881 S ARLINGTON 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:406-426-8168
Practice Address - Fax:406-723-5406
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0581103TC0700X
MT361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023124336OtherRELIANT BEHAVIORAL HEALTH EAP
MT1023124336OtherBCBS
1023124336OtherAETNA
NV1023124336OtherHORIZON HEALTH
1023124336OtherEBMS
MT1023124336OtherBUSINESS PSYCHOLOGY ASSOCIATES
NV1023124336OtherMATRIX
MT1023124336OtherALLEGIANCE BENEFIT PLAN MGMT