Healthcare Provider Details

I. General information

NPI: 1053226951
Provider Name (Legal Business Name): TRISTIN ELLIOTT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SOUTHLAND DR
MOBILE AL
36693-3313
US

IV. Provider business mailing address

1172 JACKSON COUNTY LINE RD
LUCEDALE MS
39452-4007
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-0153
  • Fax:
Mailing address:
  • Phone: 251-307-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7597G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: