MEDICARE: DR. JIMMIE J BUTCHER 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
1	103TC0700X	Clinical Psychologist	1439	AL

General Provider Information

NPI Number	:	1811104383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMIE J BUTCHER PH.D.

Provider Business Mailing Address
First Line	:	NDU HEALTH AND FITNESS 300 5TH AVE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20319-0001
Country	:	US
Telephone Number	:	202-685-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	NDU HEALTH AND FITNESS 300 5TH AVE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20319-0001
Country	:	US
Telephone Number	:	202-685-0729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/29/2024

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