Healthcare Provider Details

I. General information

NPI: 1184291148
Provider Name (Legal Business Name): PHOEBE ANN OBRECHT-BUTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 HICKORY TREE RD
SAINT CLOUD FL
34772-8906
US

IV. Provider business mailing address

1820 15TH ST
SAINT CLOUD FL
34769-4218
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-4850
  • Fax:
Mailing address:
  • Phone: 407-508-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: