Healthcare Provider Details

I. General information

NPI: 1497795694
Provider Name (Legal Business Name): MICHAEL RAY BUTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 COUNTRY MANOR BLVD STE. 5
BILLINGS MT
59102-7651
US

IV. Provider business mailing address

1430 COUNTRY MANOR BLVD STE. 5
BILLINGS MT
59102-7651
US

V. Phone/Fax

Practice location:
  • Phone: 406-294-9677
  • Fax: 406-294-9679
Mailing address:
  • Phone: 406-294-9677
  • Fax: 406-294-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number365
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: