Provider Demographics
NPI:1649987090
Name:O'STEEN, TRISTAN SLADE (MSW)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:SLADE
Last Name:O'STEEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SW GUTHRIE TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-4149
Mailing Address - Country:US
Mailing Address - Phone:386-344-1713
Mailing Address - Fax:
Practice Address - Street 1:1604 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7346
Practice Address - Country:US
Practice Address - Phone:352-548-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker