Provider Demographics
NPI:1598576399
Name:MEYER OWENS, TRISTAN GAGE
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:GAGE
Last Name:MEYER OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TRISTAN
Other - Middle Name:GAGE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11598 W ROCK VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4591
Mailing Address - Country:US
Mailing Address - Phone:520-551-5918
Mailing Address - Fax:
Practice Address - Street 1:8354 E NORTHFIELD BLVD UNIT 3700
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3135
Practice Address - Country:US
Practice Address - Phone:520-551-5918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician