Provider Demographics
NPI:1578794269
Name:WAYLAND, JAMES T (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:WAYLAND
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:403 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5285
Mailing Address - Country:US
Mailing Address - Phone:512-966-2488
Mailing Address - Fax:512-864-9319
Practice Address - Street 1:3007 DAWN DR
Practice Address - Street 2:STE 105
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2894
Practice Address - Country:US
Practice Address - Phone:512-869-6400
Practice Address - Fax:512-864-9319
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional