Healthcare Provider Details

I. General information

NPI: 1972831808
Provider Name (Legal Business Name): CHRISTOPHER HYDE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 10/21/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 DUNGENESS MDWS
SEQUIM WA
98382-9727
US

IV. Provider business mailing address

388 DUNGENESS MDWS
SEQUIM WA
98382-9727
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-1993
  • Fax:
Mailing address:
  • Phone: 410-398-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number03256
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03256
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: