Healthcare Provider Details

I. General information

NPI: 1326965047
Provider Name (Legal Business Name): TRISTAN NIETO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 MEADOWS RD STE 405
LAKE OSWEGO OR
97035-4291
US

IV. Provider business mailing address

5005 MEADOWS RD STE 405
LAKE OSWEGO OR
97035-4291
US

V. Phone/Fax

Practice location:
  • Phone: 971-232-1120
  • Fax: 855-750-2962
Mailing address:
  • Phone: 971-232-1120
  • Fax: 855-750-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: