Healthcare Provider Details

I. General information

NPI: 1457189250
Provider Name (Legal Business Name): TAMMY M BUTCHER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 VISTA DR
MOUNT HOPE WV
25880-9551
US

IV. Provider business mailing address

251 VISTA DR
MOUNT HOPE WV
25880-9551
US

V. Phone/Fax

Practice location:
  • Phone: 304-887-7408
  • Fax:
Mailing address:
  • Phone: 304-887-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number949
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: