Provider Demographics
NPI:1497470033
Name:HYATT, TRISTEN (LPC, NCC,)
Entity Type:Individual
Prefix:
First Name:TRISTEN
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:LPC, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EAST JARRARD STREET, SUITE C
Mailing Address - Street 2:PMB 166
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528
Mailing Address - Country:US
Mailing Address - Phone:706-289-8255
Mailing Address - Fax:
Practice Address - Street 1:3840 WESTMORELAND RD LOT 28
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-4867
Practice Address - Country:US
Practice Address - Phone:850-404-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty