Healthcare Provider Details

I. General information

NPI: 1568401990
Provider Name (Legal Business Name): JAMES DAVID HYDE LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 ROUTE 132
HYANNIS MA
02601-1839
US

IV. Provider business mailing address

1 PRINCES ST
HARWICH MA
02645-3107
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1839
  • Fax: 508-775-1245
Mailing address:
  • Phone: 508-432-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: