Provider Demographics
NPI:1912638107
Name:HYDE, KRISTEN (M ED)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:MCENTIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:1473 FM 2203
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-7809
Mailing Address - Country:US
Mailing Address - Phone:806-477-9726
Mailing Address - Fax:
Practice Address - Street 1:1473 FM 2203
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-7809
Practice Address - Country:US
Practice Address - Phone:806-477-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool