MEDICARE: DR. RONALD M BUTLER JR. LPC

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	101Y00000X	Counselor	3975	OK
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	3975	OK
3	101YM0800X	Mental Health Counselor	3975	OK
4	101YP2500X	Professional Counselor	3975	OK

General Provider Information

NPI Number	:	1487829321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD M BUTLER JR. LPC

Provider Business Mailing Address
First Line	:	301 W BRITTON RD UNIT 14179
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73113-4702
Country	:	US
Telephone Number	:	405-914-4700
Fax Number	:	405-914-4706

Provider Business Practice Location Address
First Line	:	6608 N WESTERN AVE
Second Line	:	252
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7326
Country	:	US
Telephone Number	:	405-605-5934
Fax Number	:

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	12/14/2021

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