Provider Demographics
NPI:1083625941
Name:BUTLER WELLNESS SUPPORT SERVICES WELLNESS WORKS
Entity Type:Organization
Organization Name:BUTLER WELLNESS SUPPORT SERVICES WELLNESS WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICKLEY
Authorized Official - Last Name:DROLET
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:724-282-0332
Mailing Address - Street 1:349 N MCKEAN STREET
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5426
Mailing Address - Country:US
Mailing Address - Phone:724-282-0332
Mailing Address - Fax:724-282-2406
Practice Address - Street 1:349 N MCKEAN STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5426
Practice Address - Country:US
Practice Address - Phone:724-282-0332
Practice Address - Fax:724-282-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008242L103T00000X
PAPS015309L103T00000X
PACW014466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017090540001Medicaid
237435OtherVALUE OPTIONS
263824OtherMAGELLAN
207142OtherUPMC CCBH
263824OtherHIGHMARK
263824OtherHIGHMARK
S58374Medicare UPIN