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NPI Code Detail

MEDICARE: TRISTAN GARRETT LICDC

MEDICARE: TRISTAN GARRETT LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162286OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114437696
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISTAN GARRETT LICDC
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 833-510-4357
Fax Number :
Provider Business Practice Location Address
First Line : 5815 WESTBOURNE AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-1459
Country : US
Telephone Number : 833-510-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2017
Last Update Date : 06/18/2024

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Directions to “ TRISTAN GARRETT LICDC” Practice Location

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