MEDICARE: TAELOR TRISTAN STATON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194673004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAELOR TRISTAN STATON

Provider Business Mailing Address
First Line	:	10815 DEVLIN DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-4719
Country	:	US
Telephone Number	:	240-990-9718
Fax Number	:

Provider Business Practice Location Address
First Line	:	10815 DEVLIN DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-4719
Country	:	US
Telephone Number	:	240-990-9718
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ TAELOR TRISTAN STATON ” Practice Location

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