Healthcare Provider Details

I. General information

NPI: 1891605143
Provider Name (Legal Business Name): TRISTAN SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BEECH ST
HOLYOKE MA
01040-3968
US

IV. Provider business mailing address

PO BOX 173
WESTMINSTER VT
05158-0173
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax:
Mailing address:
  • Phone: 802-579-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: