Healthcare Provider Details

I. General information

NPI: 1780189027
Provider Name (Legal Business Name): ALISHA BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 MISSION RD
PRAIRIE VILLAGE KS
66206-1714
US

IV. Provider business mailing address

9100 MISSION RD
PRAIRIE VILLAGE KS
66206-1714
US

V. Phone/Fax

Practice location:
  • Phone: 816-602-9665
  • Fax:
Mailing address:
  • Phone: 816-602-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number00046
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: