Provider Demographics
NPI:1083998447
Name:BUTCHER, NICHOLAS GREGORY (MS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:GREGORY
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 W KIRKWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-6129
Mailing Address - Country:US
Mailing Address - Phone:812-219-6007
Mailing Address - Fax:812-334-3885
Practice Address - Street 1:101 W KIRKWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-6129
Practice Address - Country:US
Practice Address - Phone:812-219-6007
Practice Address - Fax:812-334-3885
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health