Individual provider Active NPI

Tristan Benzon

  • Professional Counselor
  • Broomfield, CO
National Provider Identifier
1629831417
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC.0023545 Issued in CO
Practice address
12303 Airport Way Ste 125
Broomfield, CO 80021-2729
Phone
(970) 310-3406
Fax
(888) 965-4615
NPI assigned
Feb 5, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC.0023545 CO Primary
Counselor 101Y00000X 2023036734 MO
Professional Counselor 101YP2500X 20205030280 MO

Addresses

Primary practice location

12303 Airport Way Ste 125
Broomfield, CO 80021-2729

Mailing address

12303 Airport Way Ste 125
Broomfield, CO 80021-2729
Phone (970) 310-3406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250908000555 MO Practitioner - Mental Health Counselor 0143722272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1789

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2023036734MOMDCounselor
20205030280MOMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom Counseling Mo, PC CurrentSince Jul 21, 2025 Accepting new patients
Barrett Enterprise PastSince Feb 11, 2024 Accepting new patients

Locations

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1629831417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12303 AIRPORT WAY STE 125",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212729",
            "telephone_number": "970-310-3406",
            "fax_number": "888-965-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 AIRPORT WAY STE 125",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800212729",
            "telephone_number": "970-310-3406",
            "fax_number": "888-965-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENZON",
        "first_name": "TRISTAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-05",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "LPC.0023545",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2023036734",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "20205030280",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

Verify at the official NPI Registry.