Provider Demographics
NPI:1154712735
Name:MCBAIN, TRISTAN DANIELLE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:TRISTAN
Middle Name:DANIELLE
Last Name:MCBAIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:TRISTAN
Other - Middle Name:DANIELLE
Other - Last Name:DEHAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2121
Mailing Address - Country:US
Mailing Address - Phone:517-787-7920
Mailing Address - Fax:517-796-7987
Practice Address - Street 1:330 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2121
Practice Address - Country:US
Practice Address - Phone:517-787-7920
Practice Address - Fax:517-796-7987
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014695101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor