Provider Demographics
NPI:1700493632
Name:MARBUT, EVONY (LCDC)
Entity Type:Individual
Prefix:MR
First Name:EVONY
Middle Name:
Last Name:MARBUT
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9207 GUYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-4542
Mailing Address - Country:US
Mailing Address - Phone:281-686-6772
Mailing Address - Fax:
Practice Address - Street 1:204 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-3314
Practice Address - Country:US
Practice Address - Phone:713-926-9491
Practice Address - Fax:713-926-2672
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8495101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)