Provider Demographics
NPI:1598809709
Name:TRYON, ADENA DAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADENA
Middle Name:DAY
Last Name:TRYON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2746
Mailing Address - Country:US
Mailing Address - Phone:541-776-0821
Mailing Address - Fax:541-776-5011
Practice Address - Street 1:132 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2746
Practice Address - Country:US
Practice Address - Phone:541-776-0821
Practice Address - Fax:541-776-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL31791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL3179OtherLICENSE NUMBER