Provider Demographics
NPI:1083956585
Name:BUTLER, BRUCE K (MA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:K
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E MARKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3001
Mailing Address - Country:US
Mailing Address - Phone:301-741-1565
Mailing Address - Fax:
Practice Address - Street 1:19 E MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3001
Practice Address - Country:US
Practice Address - Phone:301-741-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health