=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881886810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA NORA BUTKUS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2007
-----------------------------------------------------
Last Update Date | 08/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5335 GRIGGS RD SUITE B108M
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-533-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 HARBOR LN
-----------------------------------------------------
City | KEMAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77565-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-535-0135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 36165
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------