Provider Demographics
NPI:1558246199
Name:MUNOZ, TRISTON ANDREW (LASUDC)
Entity type:Individual
Prefix:
First Name:TRISTON
Middle Name:ANDREW
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:LASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 E WELL SPRING RD APT 21X
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5024
Mailing Address - Country:US
Mailing Address - Phone:210-815-8204
Mailing Address - Fax:
Practice Address - Street 1:5983 S REDWOOD RD # 3017
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5261
Practice Address - Country:US
Practice Address - Phone:801-293-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14204995-6008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)