Healthcare Provider Details

I. General information

NPI: 1215537030
Provider Name (Legal Business Name): DOMINIQUE BUTZ LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YEARSLEY MILL ROAD
LIMA PA
19460
US

IV. Provider business mailing address

865 ROBERTS AVE
PHOENIXVILLE PA
19460-3556
US

V. Phone/Fax

Practice location:
  • Phone: 484-227-1569
  • Fax: 484-227-1406
Mailing address:
  • Phone: 610-357-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: