Healthcare Provider Details

I. General information

NPI: 1821914110
Provider Name (Legal Business Name): JAMAAL BUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 N 28TH DR STE C202
PHOENIX AZ
85029-5600
US

IV. Provider business mailing address

11248 N 49TH DR
GLENDALE AZ
85304-4002
US

V. Phone/Fax

Practice location:
  • Phone: 303-532-5749
  • Fax:
Mailing address:
  • Phone: 623-755-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: