Provider Demographics
NPI:1437961877
Name:KEBLITSCH, TRISTAN (LMFT)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:KEBLITSCH
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23371 MULHOLLAND DR # 500
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2734
Mailing Address - Country:US
Mailing Address - Phone:818-521-8005
Mailing Address - Fax:
Practice Address - Street 1:23371 MULHOLLAND DR # 500
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2734
Practice Address - Country:US
Practice Address - Phone:818-521-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10399101YM0800X
CA142105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health