MEDICARE: DR. TIA KERN-BUTLER PSY.D.

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
1	103TC2200X	Clinical Child & Adolescent Psychologist	PY6186	FL
2	103TC0700X	Clinical Psychologist	PY6186	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW378A	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184637779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIA KERN-BUTLER PSY.D.

Provider Business Mailing Address
First Line	:	12360 66TH ST STE 930
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-417-2812
Fax Number	:	727-499-6882

Provider Business Practice Location Address
First Line	:	12360 66TH ST STE 930
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3434
Country	:	US
Telephone Number	:	727-417-2812
Fax Number	:	727-499-6882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/15/2019

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