Provider Demographics
NPI:1033705090
Name:MYTON, MARIAH K (CADC I/LPC/LCPC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:K
Last Name:MYTON
Suffix:
Gender:F
Credentials:CADC I/LPC/LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59845-0572
Mailing Address - Country:US
Mailing Address - Phone:406-382-0806
Mailing Address - Fax:207-891-4458
Practice Address - Street 1:PO BOX 572
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59845-0572
Practice Address - Country:US
Practice Address - Phone:406-382-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6795101Y00000X
OR20-R-32101YA0400X
ORC7416101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500797791Medicaid
OR500787823Medicaid