Doctor Name: | DR. JERRY BUTLER |
NPI Number: | 1013267939 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D |
License Number: | |
Business Practice Address: | 330 W Gray Suite 140 Norman, OK - 73069 |
Business Phone Number: | 4059196821 |
Business Fax Number: | 4053601616 |
Mailing Address: | 4820 W Reno Ave, OKLAHOMA CITY |
State: | OK |
Postal Code: | 731276417 |
Phone Number: | 8035564333 |
Fax Number: | |
NPI Enumeration Date: | 09/18/2012 |
NPI Last Update Date: | 09/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |