Healthcare Provider Details

I. General information

NPI: 1659777183
Provider Name (Legal Business Name): PHILIP HYDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MERRIMACK ST
LOWELL MA
01854-3906
US

IV. Provider business mailing address

555 MERRIMACK ST
LOWELL MA
01854-3906
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-8656
  • Fax:
Mailing address:
  • Phone: 978-459-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: