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NPI Code Detail

MEDICARE: MRS. TRISTAN ELIZABETH THIBAULT MFT

MEDICARE: MRS. TRISTAN ELIZABETH THIBAULT MFT
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
1106H00000XMarriage & Family Therapist01149NV

General Provider Information

NPI Number : 1225365083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRISTAN ELIZABETH THIBAULT MFT
Provider Business Mailing Address
First Line : 3127 E WARM SPRINGS RD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3134
Country : US
Telephone Number : 702-813-6226
Fax Number :
Provider Business Practice Location Address
First Line : 3127 E WARM SPRINGS RD STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3134
Country : US
Telephone Number : 702-813-6226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2009
Last Update Date : 03/13/2019

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