Provider Demographics
NPI:1164279899
Name:HYDE, MADELINE RAE (MS, AMFT 141413)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:RAE
Last Name:HYDE
Suffix:
Gender:F
Credentials:MS, AMFT 141413
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5097
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-5097
Mailing Address - Country:US
Mailing Address - Phone:925-321-4253
Mailing Address - Fax:
Practice Address - Street 1:1805 WALNUT ST APT A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3610
Practice Address - Country:US
Practice Address - Phone:530-528-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT141413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist