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General NPI Number Information
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NPI Number | 1023934379
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Entity Type | Individual
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Provider Name | TRISTON SHANE ERIACHO LSAA
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Gender | Male
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | BIA RT. 125 BEHAVIORAL HEALTH ROAD
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City | PINE HILL
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State | NM
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Zip | 87357
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Country | US
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Telephone | 505-775-3353
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Fax | 505-775-3630
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Provider Business Mailing Address
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Address Line | PO BOX 490
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City | PINEHILL
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State | NM
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Zip | 87357-0490
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Country | US
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Telephone | 505-775-3353
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Fax | 505-775-3630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2023-0738
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License Number State | NM
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