Individual provider · Type 1 NPI

Trista Faye Breitenbauch, SUDP

Mental Health Counselor · Vancouver, WA

NPI number 1124576418 Active

Practice location

1601 E Fourth Plain Blvd Bldg 17
Vancouver, WA 98661-3717

Call (360) 605-7628 Map

Mailing address

PO Box 1678
Vancouver, WA 98668-1678

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400XCO 60255487 (WA)
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1124576418

Trista Faye Breitenbauch, SUDP's National Provider Identifier is 1124576418, issued on Sep 14, 2016. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Vancouver, WA. The record was last updated on Apr 20, 2021.