Healthcare Provider Details

I. General information

NPI: 1023124336
Provider Name (Legal Business Name): TRISTAN SOPHIA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 PROSPECT AVE
HELENA MT
59601-9757
US

IV. Provider business mailing address

2550 PROSPECT AVE
HELENA MT
59601-9757
US

V. Phone/Fax

Practice location:
  • Phone: 406-426-8168
  • Fax: 406-723-5406
Mailing address:
  • Phone: 406-426-8168
  • Fax: 406-723-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number361
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0581
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: