=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699151597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEAGAN M HYDE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2015
-----------------------------------------------------
Last Update Date | 08/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3035 ISLAND CREST WAY SUITE 102
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3035 ISLAND CREST WAY SUITE 102
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-395-4086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUPLES AND FAMILY THERAPIST
-----------------------------------------------------
Name | MEAGAN MARIA HYDE
-----------------------------------------------------
Credential | M.S., LMFTA
-----------------------------------------------------
Telephone | 360-471-2321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MG60330154
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------