Provider Demographics
NPI:1588729990
Name:DASHTI-GIBSON, TRISTRAM HEYWARD (LCMHC)
Entity type:Individual
Prefix:MR
First Name:TRISTRAM
Middle Name:HEYWARD
Last Name:DASHTI-GIBSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N SCOTTSDALE RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:539 ISLINGTON ST STE 4
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4471
Practice Address - Country:US
Practice Address - Phone:603-689-7890
Practice Address - Fax:603-883-0007
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3922101YM0800X
NH993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health