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NPI Code Detail

MEDICARE: TRISTIN NICHOLE COMPTON LCDCIII

MEDICARE: TRISTIN NICHOLE COMPTON LCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.161853OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104353812
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISTIN NICHOLE COMPTON LCDCIII
Provider Business Mailing Address
First Line : 113 W GAMBIER ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-2421
Country : US
Telephone Number : 740-326-9099
Fax Number :
Provider Business Practice Location Address
First Line : 113 W GAMBIER ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-2421
Country : US
Telephone Number : 740-326-9099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2017
Last Update Date : 11/10/2021

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1003386673 — SHAUNA R GAMBLE
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Directions to “ TRISTIN NICHOLE COMPTON LCDCIII” Practice Location

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