MEDICARE: MYERS, BUTLER & ASSOCIATES COUNSELING SERVICES, 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	0416066	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	493743000018805	OTHER		MAGELLAN BEHAVIORAL HEALT

General Provider Information

NPI Number	:	1639235104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYERS, BUTLER & ASSOCIATES COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	2479 MURFREESBORO PIKE
Second Line	:	SUITE 308
City	:	NASHVILLE
State	:	TN
Zip	:	37217-3554
Country	:	US
Telephone Number	:	615-366-1948
Fax Number	:	615-367-4143

Provider Business Practice Location Address
First Line	:	117 LYLE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-4732
Country	:	US
Telephone Number	:	615-366-1948
Fax Number	:	615-367-4143

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	OPHELIA RAINEY BUTLER
Credential	:	MSSW,LCSW,ACSW, MPA
Telephone Number	:	615-366-1948

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/22/2020

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