Provider Demographics
NPI:1023752284
Name:HYDEN, STACI R (MA, LCSW, CADAC II)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:R
Last Name:HYDEN
Suffix:
Gender:F
Credentials:MA, LCSW, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 S 50 E
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8011
Mailing Address - Country:US
Mailing Address - Phone:260-563-1158
Mailing Address - Fax:
Practice Address - Street 1:5233 S 50 E
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8011
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33009655A101YM0800X
IN34010538A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health