Provider Demographics
NPI:1851053839
Name:HYDE, LAJON DIMITRI
Entity type:Individual
Prefix:
First Name:LAJON
Middle Name:DIMITRI
Last Name:HYDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S LINCOLN ST APT B219
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3654
Mailing Address - Country:US
Mailing Address - Phone:909-277-4102
Mailing Address - Fax:
Practice Address - Street 1:3670 S LINCOLN ST APT B219
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3654
Practice Address - Country:US
Practice Address - Phone:909-277-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician