Provider Demographics
NPI:1275174450
Name:HYDE, SCOTT MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MATTHEW
Last Name:HYDE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9678
Mailing Address - Country:US
Mailing Address - Phone:541-295-5707
Mailing Address - Fax:
Practice Address - Street 1:432 NW 6TH ST STE 206
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2054
Practice Address - Country:US
Practice Address - Phone:541-295-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL117171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health