MEDICARE: RONNIE BUTLER, 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	251S00000X	Community/Behavioral Health Agency	3975	OK
2	101YP2500X	Professional Counselor	3975	OK

General Provider Information

NPI Number	:	1508030578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONNIE BUTLER, LPC

Provider Business Mailing Address
First Line	:	4911 N PORTLAND AVE
Second Line	:	STE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6171
Country	:	US
Telephone Number	:	405-501-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 N PORTLAND AVE
Second Line	:	STE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6171
Country	:	US
Telephone Number	:	405-501-0721
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	RONNIE BUTLER
Credential	:	LPC
Telephone Number	:	405-501-0721

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	09/23/2013

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