Provider Demographics
NPI:1083626964
Name:HYDE, TAMMY (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1171
Mailing Address - Country:US
Mailing Address - Phone:971-991-9950
Mailing Address - Fax:
Practice Address - Street 1:275 W CAMPBELL RD
Practice Address - Street 2:STE 430
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:972-918-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional