Tristan Shae Fortner, BS, RBT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.2607356 Issued in OH

Practice address

1375 US Highway 42 SE Ste C
London, OH 43140-9548

Phone

(614) 879-8067

Fax

(614) 503-0899

NPI assigned

Sep 22, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1558977751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1375 US HIGHWAY 42 SE",
            "address_2": "STE C",
            "city": "LONDON",
            "state": "OH",
            "postal_code": "431409548",
            "telephone_number": "614-879-8067",
            "fax_number": "614-503-0899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 US HIGHWAY 42 SE STE C",
            "city": "LONDON",
            "state": "OH",
            "postal_code": "431409548",
            "telephone_number": "614-879-8067",
            "fax_number": "614-503-0899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5548 Hilliard Rome Office Park",
            "address_purpose": "LOCATION",
            "city": "Hilliard",
            "state": "OH",
            "postal_code": "430267286",
            "country_code": "US",
            "telephone_number": "740-845-8652",
            "fax_number": "614-503-0899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTNER",
        "first_name": "TRISTAN",
        "middle_name": "SHAE",
        "credential": "BS, RBT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-22",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.2607356",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0040142",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cara Fleming, OTR/L
• Krista Fliger, MA/LPC
• Krystal Nicole Foley, PA-C
• Nyoka L Foor
• Beth Fordyce, R.PH
• Misty Fowler, LPN
• Melissa N Fox, PT
• Rachel Fraser, PA
• Freedom Recovery LLC
• Lindsey Friessen, OTR/L

• Mental Health Counselor in London, OH
• Providers in London, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.