Provider Demographics
NPI:1336338011
Name:MIDDLETON, TRIS L (LCSW)
Entity type:Individual
Prefix:
First Name:TRIS
Middle Name:L
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 ELM SPRINGS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2754
Mailing Address - Country:US
Mailing Address - Phone:479-435-5201
Mailing Address - Fax:
Practice Address - Street 1:3409 ELM SPRINGS RD STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2754
Practice Address - Country:US
Practice Address - Phone:479-435-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4958-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical