Provider Demographics
NPI:1235243619
Name:HYDE, GREGORY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HYDE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WOOD STREAM XING
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-2972
Mailing Address - Country:US
Mailing Address - Phone:219-548-1319
Mailing Address - Fax:219-756-6635
Practice Address - Street 1:285 W 80TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5431
Practice Address - Country:US
Practice Address - Phone:219-756-6501
Practice Address - Fax:219-756-6635
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041813A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000356954OtherANTHEM BC/BS
IN200462060AMedicaid
IL90001221OtherBC/BS OF ILLINOIS
IL90001221OtherBC/BS OF ILLINOIS