Provider Demographics
NPI:1376594739
Name:MITTON, MARILYN K (LPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:K
Last Name:MITTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-0298
Mailing Address - Country:US
Mailing Address - Phone:956-542-2536
Mailing Address - Fax:956-504-2537
Practice Address - Street 1:2039 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2499
Practice Address - Country:US
Practice Address - Phone:956-542-2536
Practice Address - Fax:956-504-2537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health