Provider Demographics
NPI:1487544730
Name:MEADOWS, TRYSTAN RAIN (PLMHP)
Entity type:Individual
Prefix:
First Name:TRYSTAN
Middle Name:RAIN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:TRYSTAN
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-2060
Mailing Address - Country:US
Mailing Address - Phone:308-650-1195
Mailing Address - Fax:
Practice Address - Street 1:916 AVENUE F
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-2060
Practice Address - Country:US
Practice Address - Phone:308-650-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health