Provider Demographics
NPI:1578696753
Name:HILL, LYLA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYLA
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NE 15TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2210
Mailing Address - Country:US
Mailing Address - Phone:541-961-8413
Mailing Address - Fax:541-264-8215
Practice Address - Street 1:132 NE 15TH ST STE D
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2210
Practice Address - Country:US
Practice Address - Phone:541-961-8413
Practice Address - Fax:541-264-8215
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC40101YA0400X
IDLCSW6621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
R158570Medicare UPIN