Doctor Name: | BONNIE BUTCHER |
NPI Number: | 1235124116 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH1908 |
Business Practice Address: | 124 E Miracle Strip Pkwy Suite 302 Mary Esther, FL - 325691988 |
Business Phone Number: | 8502438086 |
Business Fax Number: | 8502432702 |
Mailing Address: | 124 E Miracle Strip Pkwy, Suite 302 MARY ESTHER |
State: | FL |
Postal Code: | 325691988 |
Phone Number: | 8502438086 |
Fax Number: | 8502432702 |
NPI Enumeration Date: | 09/15/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH1908 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |