Healthcare Provider Details

I. General information

NPI: 1386581445
Provider Name (Legal Business Name): TRACY HYDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N WATER ST STE 138
OWOSSO MI
48867-2807
US

IV. Provider business mailing address

360 E GRAND BLANC RD STE C
GRAND BLANC MI
48439-3310
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-4224
  • Fax: 844-918-0774
Mailing address:
  • Phone: 810-230-4224
  • Fax: 844-918-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: