Individual ProviderTrista Faye BreitenbauchCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E Fourth Plain Blvd Bldg 17, Vancouver, WA 98661-3717(360) 605-7628PECOS EnrollmentBased on the most recent information from CMS, provider Trista Faye Breitenbauch does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1124576418Provider TypeIndividualFull NameBreitenbauch, Trista FayeTitleMrs.CredentialSUDPGenderFemaleSole ProprietorNoEnumeration Date9/14/2016Last Updated4/20/2021Contact InformationPractice LocationPractice Address1601 E Fourth Plain Blvd Bldg 17, Vancouver, WA 98661-3717Phone(360) 605-7628FaxUnlisted FaxMailing LocationMailing AddressPO Box 1678, Vancouver, WA 98668-1678PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCO 60255487Washington