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General NPI Number Information
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NPI Number | 1508030578
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Entity Type | Organization
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Legal Business Name | RONNIE BUTLER, LPC
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 4911 N PORTLAND AVE STE 100
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6171
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Country | US
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Telephone | 405-501-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 4911 N PORTLAND AVE STE 100
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-6171
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Country | US
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Telephone | 405-501-0721
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | RONNIE BUTLER
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Credential | LPC
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Telephone | 405-501-0721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3975
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3975
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License Number State | OK
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