Healthcare Provider Details

I. General information

NPI: 1093868689
Provider Name (Legal Business Name): REGINALD OSWALD BUTLER ED.D, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2128 CEDARGREENS RD
KNOXVILLE TN
37924-1589
US

IV. Provider business mailing address

3343 DEWINE RD
KNOXVILLE TN
37921-4211
US

V. Phone/Fax

Practice location:
  • Phone: 865-207-1568
  • Fax: 865-524-0827
Mailing address:
  • Phone: 865-584-6374
  • Fax: 865-584-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: