Healthcare Provider Details

I. General information

NPI: 1508264847
Provider Name (Legal Business Name): EARL BUTCHER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E MAIN ST SUITE 100
COLUMBUS OH
43213-2598
US

IV. Provider business mailing address

5310 E MAIN ST SUITE 100
COLUMBUS OH
43213-2598
US

V. Phone/Fax

Practice location:
  • Phone: 614-783-4860
  • Fax:
Mailing address:
  • Phone: 614-783-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number17038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: