Healthcare Provider Details

I. General information

NPI: 1619881083
Provider Name (Legal Business Name): JOEL BUTLER ED.S. NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 CLIMBING FIG DR
BLACKLICK OH
43004-7161
US

IV. Provider business mailing address

1490 CLIMBING FIG DR
BLACKLICK OH
43004-7161
US

V. Phone/Fax

Practice location:
  • Phone: 614-864-9089
  • Fax: 614-501-4672
Mailing address:
  • Phone: 614-864-9089
  • Fax: 614-501-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.03209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: