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NPI Code Detail

MEDICARE: DR. COLBY DOUGLAS BUTZON PH.D.

MEDICARE: DR. COLBY DOUGLAS BUTZON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2905TN
2103T00000XPsychologist2905TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103I680978OTHERTNMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023342136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COLBY DOUGLAS BUTZON PH.D.
Provider Business Mailing Address
First Line : 1211 UNION AVE STE 330
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-6655
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3876 NEW COVINGTON PIKE
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2512
Country : US
Telephone Number : 901-377-2711
Fax Number : 901-382-9051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2009
Last Update Date : 01/27/2026

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