Provider Demographics
NPI:1033274105
Name:HYDE, ROSALIE
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BRIAR HOLLOW LN STE 350W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-9317
Mailing Address - Country:US
Mailing Address - Phone:713-960-8450
Mailing Address - Fax:713-960-8052
Practice Address - Street 1:50 BRIAR HOLLOW LN STE 350W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9317
Practice Address - Country:US
Practice Address - Phone:713-960-8450
Practice Address - Fax:713-960-8052
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14213104100000X
TX2732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS41LMedicare UPIN