Healthcare Provider Details

I. General information

NPI: 1477947026
Provider Name (Legal Business Name): DESDAMONA BUTLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 WESTGATE CIR STE 240
BRENTWOOD TN
37027-8578
US

IV. Provider business mailing address

1604 WESTGATE CIR STE 240
BRENTWOOD TN
37027-8578
US

V. Phone/Fax

Practice location:
  • Phone: 629-900-9464
  • Fax: 855-420-5857
Mailing address:
  • Phone: 629-900-9464
  • Fax: 855-420-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number14291
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: