MEDICARE: MR. JONATHAN BUTLER

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	101YM0800X	Mental Health Counselor	242736	KY

General Provider Information

NPI Number	:	1629552047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN BUTLER

Provider Business Mailing Address
First Line	:	115 N WATTERSON TRL STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1350
Country	:	US
Telephone Number	:	502-251-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N WATTERSON TRL STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1350
Country	:	US
Telephone Number	:	502-251-1869
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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