Healthcare Provider Details

I. General information

NPI: 1386971232
Provider Name (Legal Business Name): CASSIE AMANDA HYDE LPC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 W MAIN ST
ANTLERS OK
74523-2016
US

IV. Provider business mailing address

1322 W MAIN ST
ANTLERS OK
74523-2016
US

V. Phone/Fax

Practice location:
  • Phone: 580-298-5062
  • Fax: 580-298-9958
Mailing address:
  • Phone: 580-298-5062
  • Fax: 580-298-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3792
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: