Provider Demographics
NPI:1306828637
Name:GRYTE, MARILYN A (LPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
Last Name:GRYTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ELLSWORTH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2362
Mailing Address - Country:US
Mailing Address - Phone:541-791-9164
Mailing Address - Fax:
Practice Address - Street 1:425 ELLSWORTH ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2362
Practice Address - Country:US
Practice Address - Phone:541-791-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0907101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0907OtherLPC
24384OtherNBCC