Lyders, Greta Caroline
Lyders, Greta Caroline is an sole proprietor health care provider with primary practice located at 7100 Sw Hampton St Ste 128 , Tigard OR 97223-8377. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Lyders, Greta Caroline can be contacted via phone (503) 342-2510.Contact Information
Primary practice address
7100 Sw Hampton St Ste 128
Tigard OR 97223-8377
Phone: (503) 342-2510
Fax: (503) 406-2637
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY17288 | California |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 2122 | Oregon |
Profile Details
| NPI number | 1629126081 |
|---|---|
| LBN Legal business name | Lyders, Greta Caroline |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 8th, 2007 |
| Last updated | Apr 10th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629126081 | NPPES |
| Oregon | MEDICAID | 500626679 | |
| Oregon | MEDICAID | 6HN3SQ4DL |
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