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NPI Code Detail

MEDICARE: DR. TRISTA MICHELLE HUCKLEBERRY PH.D

MEDICARE: DR. TRISTA MICHELLE HUCKLEBERRY PH.D
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
1103TC0700XClinical Psychologist36333TX

General Provider Information

NPI Number : 1326342866
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRISTA MICHELLE HUCKLEBERRY PH.D
Provider Business Mailing Address
First Line : 12700 STAFFORD RD
Second Line : APT 1118
City : STAFFORD
State : TX
Zip : 77477-3574
Country : US
Telephone Number : 346-207-7677
Fax Number :
Provider Business Practice Location Address
First Line : 5224 WILSON AVE S
Second Line : SUITE 202
City : SEATTLE
State : WA
Zip : 98118-2587
Country : US
Telephone Number : 206-725-1820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2010
Last Update Date : 02/16/2022

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