TRISTA DEMARIE BOUDON (NPI# 1740746882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740746882 |
| Entity Type | Individual |
| Full Name | TRISTA DEMARIE BOUDON |
| Practice Address |
318 S Holladay Dr Seaside OR 97138-6728 |
| Mailing Address |
65 N Highway 101 Ste 204 Warrenton OR 97146-9371 |
| Practice Telephone | 5033250241 |
| Mailing Telephone | 5033250241 |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2019-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
318 S HOLLADAY DR |
| City | SEASIDE |
| State | OR |
| Zip Code | 97138-6728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700327350 | Jada Scott | Counselor | 318 S Holladay Dr, Seaside, OR 97138-6728 | 2017-03-15 |
| 1598230468 | Rose Anna Anderson | Peer Specialist | 318 S Holladay Dr, Seaside, OR 97138-6728 | 2018-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881238376 | Abigail Mcneil | Social Worker | 1150 N Roosevelt Dr., Suite 104, Seaside, OR 97138 | 2019-10-29 |
| 1124564455 | Shelby James | Massage Therapist | 620 S Holladay Dr Ste 3, Seaside, OR 97138 | 2017-01-10 |
| 1699151902 | Joseph Alphonse Sutton | Pharmacist | 79380 Highway 202, Seaside, OR 97138 | 2015-08-10 |
| 1487047197 | Seaside Dental Clinic | Dentist | 729 S Holladay Drive, Seaside, OR 97138 | 2015-03-05 |
| 1215331020 | Jessica Jones | Massage Therapist | 1601 S. Roosevelt, Seaside, OR 97138 | 2014-10-22 |
| 1952735987 | Derk Penrod | Pharmacist | 401 S Roosevelt, Seaside, OR 97138 | 2013-08-27 |
| 1194166025 | Scott Allen Kafader | Pharmacist | 1150 N. Roosevelt Dr., Suite 104, Seaside, OR 97138 | 2013-07-08 |
| 1326391459 | Addiction Medicine Consulting | Substance Abuse Rehabilitation Facility | 1325 North Holladay Dr., Seaside, OR 97138 | 2012-10-26 |
| 1548552938 | Robert W Olson | Pharmacist | 313 S Rosevelt Drive, Seaside, OR 97138 | 2011-05-04 |
| 1831395144 | Delores Swigert Sullivan | Social Worker | 564 Pacific Way, Gearhart, OR 97138 | 2007-06-23 |
| Find all providers in zip 97138 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598230468 | Rose Anna Anderson | Peer Specialist | 318 S Holladay Dr, Seaside, OR 97138-6728 | 2018-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1578162145 | Kenneth Branson | Peer Specialist | 389 Sw Scalehouse Ct Ste 130, Bend, OR 97702-3241 | 2020-10-23 |
| 1962000554 | Dawn Marks | Peer Specialist | 21440 Se Stark St, Gresham, OR 97030-2024 | 2020-10-15 |
| 1679188080 | Michelle Marie Bunkers | Peer Specialist | 20517 Jacklight Ln, Bend, OR 97702-2971 | 2020-09-11 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1528677820 | Charice Monette | Peer Specialist | 4151 Kacey Cir Ne, Salem, OR 97305-4504 | 2020-07-23 |
| 1841810322 | Ariana Lee May | Peer Specialist | 1601 Olive St Apt 1008, Eugene, OR 97401-3985 | 2020-04-24 |
| 1982237236 | Jessica M Montoya | Peer Specialist | 235 Se Knowledge St, Prineville, OR 97754-2362 | 2020-02-14 |
| 1134752579 | Lisa Kennedy | Peer Specialist | 132 Ne B St # 24, Grants Pass, OR 97526-2114 | 2020-02-13 |
| 1730711953 | Michael Anthony Duran | Peer Specialist | 1515 Hill St Se, Albany, OR 97322-6715 | 2020-02-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.