Healthcare Provider Details

I. General information

NPI: 1689587255
Provider Name (Legal Business Name): TRISTA FEIST BROWN ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 4TH AVE E
SUPERIOR MT
59872-3075
US

IV. Provider business mailing address

PO BOX 622
SUPERIOR MT
59872-0622
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-5422
  • Fax:
Mailing address:
  • Phone: 406-822-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-90573
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: