Tristan Daeley, M.S. LBA DCR

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-15-19009 Issued in WA

Practice address

1100 S 2ND St # 1
Mount Vernon, WA 98273-4209

Phone

(360) 419-3640

Fax

(360) 419-3535

NPI assigned

Jan 16, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1972925568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S 2ND ST # 1",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734209",
            "telephone_number": "360-419-3640",
            "fax_number": "360-419-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S 2ND ST # 1",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982734209",
            "telephone_number": "360-419-3640",
            "fax_number": "360-419-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAELEY",
        "first_name": "TRISTAN",
        "credential": "M.S.  LBA DCR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-16",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG60242504",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WA",
            "license": "BA60791227",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WA",
            "license": "1-15-19009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Behavior Analyst in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.