Provider Demographics
NPI:1134233596
Name:GREGORY HYDE PSYD LLC
Entity type:Organization
Organization Name:GREGORY HYDE PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:219-756-6501
Mailing Address - Street 1:285 W 80TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5431
Mailing Address - Country:US
Mailing Address - Phone:219-756-6501
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000356954OtherANTHEM BC/BS
IN200462060Medicaid
IL90001221OtherBC/BS OF ILLINOIS
IN224520Medicare ID - Type Unspecified