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NPI Code Detail

MEDICARE: JUANITA BUTLER

MEDICARE: JUANITA 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 Counselor

General Provider Information

NPI Number : 1174951461
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUANITA BUTLER
Provider Business Mailing Address
First Line : 2302 PARKLAKE DR NE STE 350
Second Line :
City : ATLANTA
State : GA
Zip : 30345-2918
Country : US
Telephone Number : 770-621-0469
Fax Number : 770-621-0466
Provider Business Practice Location Address
First Line : 2302 PARKLAKE DR NE STE 350
Second Line :
City : ATLANTA
State : GA
Zip : 30345-2918
Country : US
Telephone Number : 770-621-0469
Fax Number : 770-621-0466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2013
Last Update Date : 10/23/2013

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Directions to “ JUANITA BUTLER ” Practice Location

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