MEDICARE: MICHAEL J. & JOANN BUTERA INC.

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

General Provider Information

NPI Number	:	1568655520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J. & JOANN BUTERA INC.

Provider Business Mailing Address
First Line	:	1801 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	713-524-0142
Fax Number	:	713-524-7885

Provider Business Practice Location Address
First Line	:	1801 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	713-524-0142
Fax Number	:	713-524-7885

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL JOSEPH BUTERA
Credential	:	M.S.W, L.C.S.W.
Telephone Number	:	713-524-0142

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/23/2007

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