Provider Demographics
NPI:1558413591
Name:LYTE, KATHERINE RUTH (LCSW 1190)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:RUTH
Last Name:LYTE
Suffix:
Gender:F
Credentials:LCSW 1190
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 NW ASPEN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-223-9325
Mailing Address - Fax:
Practice Address - Street 1:421 SW OAK
Practice Address - Street 2:SUITE 520 LINCOLN BUILDING
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204
Practice Address - Country:US
Practice Address - Phone:503-988-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical