Provider Demographics
NPI:1073540985
Name:SAYRE-BUTT, PAMELA R (LISW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:SAYRE-BUTT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 STATE ROUTE 159
Mailing Address - Street 2:PO BOX 6179
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-6179
Mailing Address - Country:US
Mailing Address - Phone:740-775-1260
Mailing Address - Fax:740-773-1264
Practice Address - Street 1:4449 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-6179
Practice Address - Country:US
Practice Address - Phone:740-775-1260
Practice Address - Fax:740-773-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH200394000OtherMAGELLAN
OH000000003755OtherANTHEM
OH200394000OtherMAGELLAN
OHSASW33913Medicare PIN
OHSASW33914Medicare PIN
OHSASW33915Medicare PIN
OHSASW33911Medicare PIN