Healthcare Provider Details

I. General information

NPI: 1023257094
Provider Name (Legal Business Name): TRISTAN SHANNON WOZNIAK M.A. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISTAN SHANNON PIXLEY SCHNEIDER

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/22/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 11TH AVE STE B
LONGVIEW WA
98632-2555
US

IV. Provider business mailing address

26 FLANDERSVILLE RD
CATHLAMET WA
98612-9541
US

V. Phone/Fax

Practice location:
  • Phone: 360-414-8600
  • Fax:
Mailing address:
  • Phone: 360-270-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60887869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: