MEDICARE: ELLEN JEAN HYDE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780050252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JEAN HYDE

Provider Business Mailing Address
First Line	:	36 SW NYE ST
Second Line	:	LINCOLN COUNTY HEALTH AND HUMAN SERVICES
City	:	NEWPORT
State	:	OR
Zip	:	97365
Country	:	US
Telephone Number	:	541-574-5960
Fax Number	:	541-265-0601

Provider Business Practice Location Address
First Line	:	4909 S COAST HWY
Second Line	:	SUITE 1
City	:	SOUTH BEACH
State	:	OR
Zip	:	97366-9648
Country	:	US
Telephone Number	:	541-574-5960
Fax Number	:	541-265-0601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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