Provider Demographics
NPI:1447294327
Name:MARRIOTT, MERILYN HOWTON (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:MERILYN
Middle Name:HOWTON
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:MERILYN
Other - Middle Name:FAYE
Other - Last Name:HOWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 1342
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77670-1342
Mailing Address - Country:US
Mailing Address - Phone:409-769-1824
Mailing Address - Fax:409-769-1829
Practice Address - Street 1:157 LOWE ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-3844
Practice Address - Country:US
Practice Address - Phone:409-769-1824
Practice Address - Fax:409-769-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional