Provider Demographics
NPI:1497432553
Name:MITTON, MOLLY GRACE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:GRACE
Last Name:MITTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16712 HUFFMEISTER RD UNIT 500
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-8050
Mailing Address - Country:US
Mailing Address - Phone:281-746-6037
Mailing Address - Fax:
Practice Address - Street 1:16712 HUFFMEISTER RD UNIT 500
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-8050
Practice Address - Country:US
Practice Address - Phone:281-746-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician