Individual
MARIA LYTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3050 SE DIVISION ST, PORTLAND, OR 97202-1898
(503) 622-8964
Mailing address
3050 SE DIVISION ST STE 215, PORTLAND, OR 97202-1997
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12481994
—
OR
Enumeration date
05/13/2020
Last updated
05/13/2020
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