Provider Demographics
NPI:1013515071
Name:WHARTON, MARLON A
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:A
Last Name:WHARTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SHEPLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-3505
Mailing Address - Country:US
Mailing Address - Phone:314-255-9665
Mailing Address - Fax:
Practice Address - Street 1:5261 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1063
Practice Address - Country:US
Practice Address - Phone:314-449-1180
Practice Address - Fax:314-449-1181
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health