Provider Demographics
NPI:1104941822
Name:PERYAM, MARILYN (MS)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:PERYAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MARILEE
Other - Middle Name:
Other - Last Name:PERYAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2250 PATTERSON ST UNIT 216
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8903
Mailing Address - Country:US
Mailing Address - Phone:541-484-4428
Mailing Address - Fax:
Practice Address - Street 1:20 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3535
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist