Active NPI
Tristan Danielle McBain, LLPC
- Counselor
- Jackson, MI
National Provider Identifier
1154712735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 6401014695
- Practice address
- 330 W Michigan Ave
Jackson, MI 49201-2121 - Phone
- (517) 787-7920
- Fax
- (517) 796-7987
- NPI assigned
- Feb 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6401014695 | MI | Primary |
Addresses
Primary practice location
330 W Michigan Ave
Jackson, MI 49201-2121
Mailing address
330 W Michigan Ave
Jackson, MI 49201-2121
Phone (517) 787-7920
Other names 1
- Tristan Danielle Dehaven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Previously, effective Aug 17, 2024 through Aug 17, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401014695 | MI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424217600000",
"number": "1154712735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 W MICHIGAN AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492012121",
"telephone_number": "517-787-7920",
"fax_number": "517-796-7987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 W MICHIGAN AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492012121",
"telephone_number": "517-787-7920",
"fax_number": "517-796-7987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCBAIN",
"first_name": "TRISTAN",
"middle_name": "DANIELLE",
"name_prefix": "Mrs.",
"credential": "LLPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-18",
"last_updated": "2015-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MI",
"license": "6401014695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRISTAN",
"last_name": "DEHAVEN",
"middle_name": "DANIELLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.