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General NPI Number Information
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NPI Number | 1982749743
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Entity Type | Individual
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Provider Name | MARYDALE G SALSTON PH.D., LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4455 NE HIGHWAY 20
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City | CORVALLIS
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State | OR
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Zip | 97330-9695
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Country | US
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Telephone | 541-758-5947
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Fax | 541-757-1944
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Provider Business Mailing Address
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Address Line | 335 CHICAGO ST SE
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City | ALBANY
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State | OR
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Zip | 97321-4852
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Country | US
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Telephone | 541-791-4876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0518
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License Number State | OR
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