Basic Information
| Provider Information | |||||||||
| NPI: | 1013077965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYDE | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | SHAW | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAMILTON | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | SHAW | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3540 GENESSEE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641113963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167537056 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1260 NE WINDSOR DR | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640865594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163478777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2005022242 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.