Provider Demographics
NPI:1023257094
Name:WOZNIAK, TRISTAN SHANNON (MA LMHC)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:SHANNON
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:TRISTAN
Other - Middle Name:SHANNON PIXLEY
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 FLANDERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-9541
Mailing Address - Country:US
Mailing Address - Phone:360-270-6128
Mailing Address - Fax:
Practice Address - Street 1:945 11TH AVE STE B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2555
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60887869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2124444Medicaid