MEDICARE: BECKY BUTLER, LCSW, INC.

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	1041C0700X	Clinical Social Worker	1897	GA

General Provider Information

NPI Number	:	1376615617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKY BUTLER, LCSW, INC.

Provider Business Mailing Address
First Line	:	4118 CLAIRMONT RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-3237
Country	:	US
Telephone Number	:	770-451-0939
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 CLAIRMONT RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-3237
Country	:	US
Telephone Number	:	770-451-0939
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECCA BUTLER
Credential	:	LCSW
Telephone Number	:	770-451-0939

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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