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General NPI Number Information
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NPI Number | 1326342866
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Entity Type | Individual
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Provider Name | TRISTA MICHELLE HUCKLEBERRY PH.D
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Gender | Female
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Dates
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Enumeration Date | 12/25/2010
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 5224 WILSON AVE S SUITE 202
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City | SEATTLE
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State | WA
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Zip | 98118-2587
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Country | US
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Telephone | 206-725-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 12700 STAFFORD RD APT 1118
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City | STAFFORD
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State | TX
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Zip | 77477-3574
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Country | US
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Telephone | 346-207-7677
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36333
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License Number State | TX
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