Provider Demographics
NPI:1902216708
Name:HYLAND, JAMES PATRICK (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:HYLAND
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:HYLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JD, MA
Mailing Address - Street 1:1705 CENTENNIAL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3320
Mailing Address - Country:US
Mailing Address - Phone:541-818-0009
Mailing Address - Fax:541-780-6967
Practice Address - Street 1:1705 CENTENNIAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3320
Practice Address - Country:US
Practice Address - Phone:541-818-0009
Practice Address - Fax:541-780-6967
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6940101YP2500X
ORR6737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500798164Medicaid