Provider Demographics
NPI:1285999847
Name:COLLIER, HAYDEN LEINE (MS)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:LEINE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 SE MAIN ST UNIT 220159
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97269-0815
Mailing Address - Country:US
Mailing Address - Phone:503-966-8437
Mailing Address - Fax:503-334-2494
Practice Address - Street 1:3125B NE HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2504
Practice Address - Country:US
Practice Address - Phone:503-966-8437
Practice Address - Fax:503-334-2494
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR195164Medicaid