Provider Demographics
NPI:1013077965
Name:HYDE, CHRISTINA SHAW (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SHAW
Last Name:HYDE
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:SHAW
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3540 GENESSEE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3963
Mailing Address - Country:US
Mailing Address - Phone:816-753-7056
Mailing Address - Fax:
Practice Address - Street 1:1260 NE WINDSOR DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5594
Practice Address - Country:US
Practice Address - Phone:816-347-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050222421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical