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General NPI Number Information
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NPI Number | 1841346095
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Entity Type | Individual
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Provider Name | MAURICE BUTLER JR. BCBA
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Gender | Male
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4942 NOEL MISSION DR
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City | MEMPHIS
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State | TN
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Zip | 38125-4783
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Country | US
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Telephone | 901-870-2341
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Fax | 901-755-6805
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Provider Business Mailing Address
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Address Line | 4942 NOEL MISSION DR
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City | MEMPHIS
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State | TN
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Zip | 38125-4783
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Country | US
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Telephone | 901-870-2341
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Fax | 901-755-6805
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 1-06-2770
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License Number State | TN
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