Healthcare Provider Details

I. General information

NPI: 1619151669
Provider Name (Legal Business Name): SHIRLEY ANN BUTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 7TH NWAVE
RONAN MT
59864-2218
US

IV. Provider business mailing address

PO BOX 709
RONAN MT
59864-0709
US

V. Phone/Fax

Practice location:
  • Phone: 406-546-7497
  • Fax:
Mailing address:
  • Phone: 406-546-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number815
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: