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NPI Code Detail

MEDICARE: PRISCILLA C BUTLER, PSYD, LLC

MEDICARE: PRISCILLA C BUTLER, PSYD, LLC
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1417505314
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRISCILLA C BUTLER, PSYD, LLC
Provider Business Mailing Address
First Line : 30 N MICHIGAN AVE STE 1622
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3668
Country : US
Telephone Number : 773-424-2128
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 1622
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3668
Country : US
Telephone Number : 773-424-2128
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST / OWNER
Name : DR. PRISCILLA CAMPBELL BUTLER
Credential : PSY.D.
Telephone Number : 773-424-2128
Provider Enumeration Date : 09/04/2019
Last Update Date : 08/05/2020

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