MEDICARE: MEAGAN M HYDE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MG60330154	WA

General Provider Information

NPI Number	:	1699151597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEAGAN M HYDE, LLC

Provider Business Mailing Address
First Line	:	3035 ISLAND CREST WAY
Second Line	:	SUITE 102
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2919
Country	:	US
Telephone Number	:	425-395-4086
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 ISLAND CREST WAY
Second Line	:	SUITE 102
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2919
Country	:	US
Telephone Number	:	425-395-4086
Fax Number	:

Authorized Official
Title or Position	:	COUPLES AND FAMILY THERAPIST
Name	:	MEAGAN MARIA HYDE
Credential	:	M.S., LMFTA
Telephone Number	:	360-471-2321

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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