Provider Demographics
NPI:1114491321
Name:BUTLER, NAKENDRA RASHAE
Entity Type:Individual
Prefix:
First Name:NAKENDRA
Middle Name:RASHAE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-4445
Mailing Address - Country:US
Mailing Address - Phone:903-275-5065
Mailing Address - Fax:
Practice Address - Street 1:219 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-4445
Practice Address - Country:US
Practice Address - Phone:903-275-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service