Provider Demographics
NPI:1447856547
Name:MILLIKIN, TRISTYN KAYLA (MED, LPC)
Entity type:Individual
Prefix:
First Name:TRISTYN
Middle Name:KAYLA
Last Name:MILLIKIN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:TRISTYN
Other - Middle Name:KAYLA
Other - Last Name:BURCHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 TOKALAUN DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 TOKALAUN DR
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2169
Practice Address - Country:US
Practice Address - Phone:512-925-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84819101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty