Healthcare Provider Details

I. General information

NPI: 1548470255
Provider Name (Legal Business Name): MARIAN JONES BUTCHER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 EAST BROADWAY
JACKSON WY
83001-3009
US

IV. Provider business mailing address

PO BOX 3009
JACKSON WY
83001-3009
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-7224
  • Fax: 307-733-7224
Mailing address:
  • Phone: 307-733-7224
  • Fax: 307-733-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number144
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number144
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number144
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number144
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: