Doctor Name: | MS. SANDRA SMYTH HYDE |
NPI Number: | 1588785174 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | LCPC 246 |
Business Practice Address: | 710 Wood River Drive Ketchum, ID - 833402512 |
Business Phone Number: | 2087269051 |
Business Fax Number: | |
Mailing Address: | Po Box 2512, KETCHUM |
State: | ID |
Postal Code: | 833402512 |
Phone Number: | 2087269051 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LCPC 246 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |