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NPI Code Detail

MEDICARE: TRISTAN ERIK HEDIGER BA

MEDICARE: TRISTAN ERIK HEDIGER BA
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
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356777312
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISTAN ERIK HEDIGER BA
Provider Business Mailing Address
First Line : 435 NE EVANS ST # A
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-4628
Country : US
Telephone Number : 503-472-4020
Fax Number :
Provider Business Practice Location Address
First Line : 435 NE EVANS ST # A
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-4628
Country : US
Telephone Number : 503-472-4020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2013
Last Update Date : 03/05/2021

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