Healthcare Provider Details

I. General information

NPI: 1205098779
Provider Name (Legal Business Name): MARY MARGARET HYLAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 03/23/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-229-2360
Mailing address:
  • Phone: 216-791-3800
  • Fax: 216-229-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1300323
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0021236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: