MEDICARE: BONNIE BUTCHER LMHC

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	101YM0800X	Mental Health Counselor	MH1908	FL

General Provider Information

NPI Number	:	1235124116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE BUTCHER LMHC

Provider Business Mailing Address
First Line	:	124 E MIRACLE STRIP PKWY
Second Line	:	SUITE 302
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-1988
Country	:	US
Telephone Number	:	850-243-8086
Fax Number	:	850-243-2702

Provider Business Practice Location Address
First Line	:	124 E MIRACLE STRIP PKWY
Second Line	:	SUITE 302
City	:	MARY ESTHER
State	:	FL
Zip	:	32569-1988
Country	:	US
Telephone Number	:	850-243-8086
Fax Number	:	850-243-2702

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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