Provider Demographics
NPI:1083799258
Name:BUTLER WELLNESS SUPPORT SERVICES
Entity Type:Organization
Organization Name:BUTLER WELLNESS SUPPORT SERVICES
Other - Org Name:WELLNESS WORKS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
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 ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4928
Mailing Address - Country:US
Mailing Address - Phone:724-282-0332
Mailing Address - Fax:724-282-2406
Practice Address - Street 1:349 N MCKEAN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4928
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:2006-10-26
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008242L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1589625OtherHIGHMARK
PAS58374Medicare UPIN