Provider Demographics
NPI:1710403266
Name:HYDE, JACOB NATHANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NATHANIEL
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 1:5620 N TUCSON MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7634
Mailing Address - Country:US
Mailing Address - Phone:202-930-3393
Mailing Address - Fax:
Practice Address - Street 1:5620 N TUCSON MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7634
Practice Address - Country:US
Practice Address - Phone:202-930-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005044103TC2200X, 103TC0700X, 103TH0004X
CO0004648103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical