Healthcare Provider Details

I. General information

NPI: 1356660807
Provider Name (Legal Business Name): THERESA BUTLER M.ED., LPCC-S, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MONROE ST STE 200
TOLEDO OH
43623-3466
US

IV. Provider business mailing address

PO BOX 8970
TOLEDO OH
43623-0970
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-4449
  • Fax: 419-479-3832
Mailing address:
  • Phone: 419-241-6191
  • Fax: 419-255-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0002586-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 1303140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: