Provider Demographics
NPI:1407570807
Name:HAMPTON, TRISTISA YVETTE (LSW)
Entity Type:Individual
Prefix:MISS
First Name:TRISTISA
Middle Name:YVETTE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 N LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-1310
Mailing Address - Country:US
Mailing Address - Phone:317-492-7738
Mailing Address - Fax:
Practice Address - Street 1:4954 E 56TH ST STE 9
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5769
Practice Address - Country:US
Practice Address - Phone:317-683-0051
Practice Address - Fax:317-562-0905
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99112419A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor