Provider Demographics
NPI:1841478583
Name:HYDE, JEFFREY WAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:HYDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42690 WOODWARD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5062
Mailing Address - Country:US
Mailing Address - Phone:248-454-0129
Mailing Address - Fax:
Practice Address - Street 1:42690 WOODWARD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5062
Practice Address - Country:US
Practice Address - Phone:248-454-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005918103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI62-0-F3-4907OtherBCBS OF MI