Provider Demographics
NPI:1295052520
Name:MARX, LYNDA K (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:K
Last Name:MARX
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CLUB RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2420
Mailing Address - Country:US
Mailing Address - Phone:541-393-5983
Mailing Address - Fax:
Practice Address - Street 1:66 CLUB RD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2463
Practice Address - Country:US
Practice Address - Phone:541-393-5983
Practice Address - Fax:541-393-5984
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500661812Medicaid