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General NPI Number Information
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NPI Number | 1518142041
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Entity Type | Individual
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Provider Name | ANDRE PAUL BUTEAU PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | HIGHWAY 475 SOUTH HUDSPETH REGIONAL CENTER
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City | WHITFIELD
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State | MS
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Zip | 39193-1032
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Country | US
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Telephone | 601-664-6195
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Fax | 601-359-6945
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Provider Business Mailing Address
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Address Line | PO BOX 127B
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City | WHITFIELD
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State | MS
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Zip | 39193-1032
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Country | US
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Telephone | 601-664-6195
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Fax | 601-359-6945
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 33521
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 33521
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License Number State | MS
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