Provider Demographics
NPI:1245863703
Name:GALLARDO-STEWART, TRISTANNE DANAE (LMFT)
Entity type:Individual
Prefix:
First Name:TRISTANNE
Middle Name:DANAE
Last Name:GALLARDO-STEWART
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 1:169 HARTNELL AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1860
Mailing Address - Country:US
Mailing Address - Phone:530-440-6212
Mailing Address - Fax:
Practice Address - Street 1:169 HARTNELL AVE STE 208
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1860
Practice Address - Country:US
Practice Address - Phone:530-440-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist