Provider Demographics
NPI:1841458403
Name:WHITTON, MARILYN WEBSTER (MED, LPC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:WEBSTER
Last Name:WHITTON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 S LOOP 256 STE R
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8498
Mailing Address - Country:US
Mailing Address - Phone:903-723-0911
Mailing Address - Fax:903-723-0999
Practice Address - Street 1:4002 S LOOP 256 STE R
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8498
Practice Address - Country:US
Practice Address - Phone:903-723-0911
Practice Address - Fax:903-723-0999
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11361102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst