Provider Demographics
NPI:1982436432
Name:HILTON, MARYELLEN KAY (LCSW, QMHP)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:KAY
Last Name:HILTON
Suffix:
Gender:F
Credentials:LCSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 EASTGATE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-5691
Mailing Address - Country:US
Mailing Address - Phone:605-224-5811
Mailing Address - Fax:
Practice Address - Street 1:2001 EASTGATE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-5691
Practice Address - Country:US
Practice Address - Phone:605-224-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD63411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical