Provider Demographics
NPI:1336319359
Name:GREEN, DARRYLA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DARRYLA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:DARRYLA
Other - Middle Name:GREEN
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4060 NW HOUSTON PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1722
Mailing Address - Country:US
Mailing Address - Phone:541-757-2084
Mailing Address - Fax:
Practice Address - Street 1:4060 NW HOUSTON PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1722
Practice Address - Country:US
Practice Address - Phone:541-757-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist