Healthcare Provider Details

I. General information

NPI: 1134893571
Provider Name (Legal Business Name): TRINITI TERRE' CELENE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD
DETROIT MI
48238-3710
US

IV. Provider business mailing address

20250 SAINT MARYS ST
DETROIT MI
48235-2133
US

V. Phone/Fax

Practice location:
  • Phone: 313-883-7246
  • Fax:
Mailing address:
  • Phone: 313-333-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: