Provider Demographics
NPI:1780389833
Name:PATRICK, DANIEL JAYLIN
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAYLIN
Last Name:PATRICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 N VANCOUVER WAY # 64301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7530
Mailing Address - Country:US
Mailing Address - Phone:206-752-3715
Mailing Address - Fax:
Practice Address - Street 1:10350 N VANCOUVER WAY # 64301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7530
Practice Address - Country:US
Practice Address - Phone:206-752-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61643244101Y00000X
TX92900101Y00000X
ORR10469101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor