Provider Demographics
NPI:1558439406
Name:DYE, GRIFFITH R (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRIFFITH
Middle Name:R
Last Name:DYE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W LORAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1096
Mailing Address - Country:US
Mailing Address - Phone:440-774-7474
Mailing Address - Fax:440-775-7570
Practice Address - Street 1:224 W LORAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1096
Practice Address - Country:US
Practice Address - Phone:440-774-7474
Practice Address - Fax:440-775-7570
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4875103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2642019Medicaid
OHQ38797Medicare UPIN
OHDYCP30922Medicare UPIN