Healthcare Provider Details

I. General information

NPI: 1588965982
Provider Name (Legal Business Name): JONATHAN L BUTTREY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 E 5625 S APT B
OGDEN UT
84403-5967
US

IV. Provider business mailing address

1812 E 5625 S APT B
OGDEN UT
84403-5967
US

V. Phone/Fax

Practice location:
  • Phone: 928-600-5843
  • Fax:
Mailing address:
  • Phone: 928-600-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7839862-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: