MEDICARE: MISS TRISTISA YVETTE HAMPTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	34011747A	IN

General Provider Information

NPI Number	:	1407570807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TRISTISA YVETTE HAMPTON LCSW

Provider Business Mailing Address
First Line	:	697 PRO MED LN
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-5323
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-674-0060

Provider Business Practice Location Address
First Line	:	201 SHELBY ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3943
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-674-0060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	06/18/2026

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