Provider Demographics
NPI:1669757266
Name:BYRNES, TRISTAN W (LMHC)
Entity type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:W
Last Name:BYRNES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3936
Mailing Address - Country:US
Mailing Address - Phone:813-919-6185
Mailing Address - Fax:
Practice Address - Street 1:447 3RD AVE N STE 210
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3255
Practice Address - Country:US
Practice Address - Phone:813-919-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health