Provider Demographics
NPI:1073122545
Name:BUTRICKS, DARYL (REGIONAL MANAGER)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:BUTRICKS
Suffix:
Gender:M
Credentials:REGIONAL MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 E HWY 69 SUITE 201
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:96314
Mailing Address - Country:US
Mailing Address - Phone:928-442-9205
Mailing Address - Fax:
Practice Address - Street 1:9128 E HWY 69 SUITE 201
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:96314
Practice Address - Country:US
Practice Address - Phone:928-442-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician