Provider Demographics
NPI:1326933631
Name:FREELS, TRISTAN ADAM
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:ADAM
Last Name:FREELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25381 NW COUNTY ROAD 333
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-4425
Mailing Address - Country:US
Mailing Address - Phone:850-643-8292
Mailing Address - Fax:850-643-8292
Practice Address - Street 1:11288 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3481
Practice Address - Country:US
Practice Address - Phone:850-601-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician