Provider Demographics
NPI:1831504927
Name:HYDE, TRESA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TRESA
Other - Middle Name:HYDE
Other - Last Name:RUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:162 N 350 W APT A
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5623
Mailing Address - Country:US
Mailing Address - Phone:801-949-3471
Mailing Address - Fax:
Practice Address - Street 1:162 N 350 W APT A
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5623
Practice Address - Country:US
Practice Address - Phone:801-949-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical