Provider Demographics
NPI:1194260471
Name:MARLENE LITTLETON, LLC
Entity type:Organization
Organization Name:MARLENE LITTLETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-820-0306
Mailing Address - Street 1:1911 LOUGHREY ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3097
Mailing Address - Country:US
Mailing Address - Phone:816-820-0306
Mailing Address - Fax:
Practice Address - Street 1:1170 W KANSAS ST
Practice Address - Street 2:BUILDING 10
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2036
Practice Address - Country:US
Practice Address - Phone:816-820-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW005482251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health