MEDICARE: LISA BUTTS

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	103TS0200X	School Psychologist		OH

General Provider Information

NPI Number	:	1528502689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BUTTS

Provider Business Mailing Address
First Line	:	8 ENFIELD ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45218-1434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 ENFIELD ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45218-1434
Country	:	US
Telephone Number	:	513-619-2336
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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Directions to “ LISA BUTTS ” Practice Location

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