MEDICARE: JOHN BUTLER LMSW, ACP, PH.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	1041C0700X	Clinical Social Worker	16346	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120905	OTHER	TX	SUPERIOR
2	7173124	OTHER	TX	AETNA BEHAVIORAL HEALTH
3	120905	OTHER	TX	TTC CHIPS
4	200869	OTHER	TX	MHN
5	136320	OTHER	TX	VALUEOPTIONS
6	64688	OTHER	TX	CSHCN
7	255185	OTHER	TX	COMPSYCH
8	00508E	OTHER	TX	BLUE CROSS BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417956632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BUTLER LMSW, ACP, PH.D.

Provider Business Mailing Address
First Line	:	1808 ROSE ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-723-4488
Fax Number	:	940-723-0446

Provider Business Practice Location Address
First Line	:	1808 ROSE ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-4219
Country	:	US
Telephone Number	:	940-723-4488
Fax Number	:	940-723-0446

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/09/2012

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