Basic Information
| Provider Information | |||||||||
| NPI: | 1336338011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDDLETON | ||||||||
| FirstName: | TRIS | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMSW/CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 23070 | ||||||||
| Address2: | |||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72923 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 4794525040 | ||||||||
| FaxNumber: | 4794525047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 FORT ST. | ||||||||
| Address2: | SUITE J | ||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794525040 | ||||||||
| FaxNumber: | 4794525047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2007 | ||||||||
| LastUpdateDate: | 11/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 1877-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.