Provider Demographics
NPI:1033752712
Name:BUTZ, THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BUTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MONTCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1301
Mailing Address - Country:US
Mailing Address - Phone:831-566-9588
Mailing Address - Fax:
Practice Address - Street 1:111 MONTCLAIR DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1301
Practice Address - Country:US
Practice Address - Phone:831-566-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist