MEDICARE: KATHARINE EDEN SMITH HYDER LCMHC-QS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	72994	TX
2	101YM0800X	Mental Health Counselor	16344	NC

General Provider Information

NPI Number	:	1336977354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE EDEN SMITH HYDER LCMHC-QS, LPC

Provider Business Mailing Address
First Line	:	3017 MCLENDON RD
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104-8515
Country	:	US
Telephone Number	:	214-802-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	10720 SIKES PL STE 120
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8142
Country	:	US
Telephone Number	:	972-729-9136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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