Provider Demographics
NPI:1184046633
Name:HYDO, RICHARD IV (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HYDO
Suffix:IV
Gender:M
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 E 300 S STE 113
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3844
Mailing Address - Country:US
Mailing Address - Phone:801-980-3402
Mailing Address - Fax:801-931-2049
Practice Address - Street 1:556 E 300 S STE 113
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3844
Practice Address - Country:US
Practice Address - Phone:801-980-3402
Practice Address - Fax:801-931-2049
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6255312-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical