MEDICARE: TRISTEN HYATT LPC, NCC,

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	101YM0800X	Mental Health Counselor	011078	GA

General Provider Information

NPI Number	:	1497470033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISTEN HYATT LPC, NCC,

Provider Business Mailing Address
First Line	:	250 EAST JARRARD STREET, SUITE C
Second Line	:	PMB 166
City	:	CLEVELAND
State	:	GA
Zip	:	30528
Country	:	US
Telephone Number	:	706-289-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 WESTMORELAND RD LOT 28
Second Line	:
City	:	CLEVELAND
State	:	GA
Zip	:	30528-4867
Country	:	US
Telephone Number	:	850-404-4232
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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