Individual provider Active NPI

Tara Hyde, PSYD

  • Clinical Psychologist
  • Long Beach, CA
National Provider Identifier
1104979202
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY26452 Issued in CA
Practice address
2600 Redondo Ave FL 3
Long Beach, CA 90806-2325
Phone
(562) 256-2929
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY26452 CA Primary

Addresses

Primary practice location

2600 Redondo Ave FL 3
Long Beach, CA 90806-2325

Mailing address

2600 Redondo Ave FL 3
Long Beach, CA 90806-2325
Phone (562) 256-2929

Other practice location 1

437 N Hoover St
Los Angeles, CA 90004-2306
Phone (323) 644-2030 ext. 201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150615002614 CA Practitioner - Clinical Psychologist 9830400084 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY26452CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Apr 14, 2015 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Apr 14, 2015 Accepting new patients

Locations

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1104979202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 REDONDO AVE FL 3",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062325",
            "telephone_number": "562-256-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 REDONDO AVE FL 3",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062325",
            "telephone_number": "562-256-2929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "437 N Hoover St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900042306",
            "country_code": "US",
            "telephone_number": "323-644-2030 x201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HYDE",
        "first_name": "TARA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY26452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.