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General NPI Number Information
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NPI Number | 1295975969
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Entity Type | Organization
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Legal Business Name | MICHELLE BUTLER
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 2170 W. STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32779
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Country | US
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Telephone | 407-733-2326
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Fax | 407-327-9058
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Provider Business Mailing Address
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Address Line | 564 GREEN SPRING CIR
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-3012
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Country | US
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Telephone | 407-733-2326
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Fax | 407-327-9058
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Authorized Official
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Title or Position | CLINICAL PSYCHOLGIST
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Name | DR. MICHELLE ANDREA BUTLER
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Credential | PSYD
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Telephone | 407-733-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7574
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License Number State | FL
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