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NPI Code Detail

MEDICARE: KYLE BUTLER

MEDICARE: KYLE BUTLER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorR9341OR

General Provider Information

NPI Number : 1174111611
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE BUTLER
Provider Business Mailing Address
First Line : 1112 EMMETT LOOP
Second Line :
City : SILVERTON
State : OR
Zip : 97381-8763
Country : US
Telephone Number : 801-616-9293
Fax Number :
Provider Business Practice Location Address
First Line : 10580 SW MCDONALD ST STE 205
Second Line :
City : TIGARD
State : OR
Zip : 97224-4800
Country : US
Telephone Number : 801-616-9293
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2021
Last Update Date : 06/21/2024

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Directions to “ KYLE BUTLER ” Practice Location

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