Provider Demographics
NPI:1538577002
Name:HYLAND, MICHAEL KEVIN II
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEVIN
Last Name:HYLAND
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:KEVIN
Other - Last Name:HYLAND
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4353 PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-9197
Mailing Address - Country:US
Mailing Address - Phone:919-222-7049
Mailing Address - Fax:
Practice Address - Street 1:2700 ROBERT T LONGWAY BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2190
Practice Address - Country:US
Practice Address - Phone:810-257-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1235115460103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst