Individual
DR. KELLY L HYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPCC, CHT, BCPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CCMH0186911
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73725773
—
NM
Enumeration date
03/09/2009
Last updated
12/02/2019
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