Provider Demographics
NPI:1164761292
Name:BUTLER, SANDRA (LLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 W SAGINAW ST # G
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2434
Mailing Address - Country:US
Mailing Address - Phone:517-483-2461
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:1422 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2434
Practice Address - Country:US
Practice Address - Phone:517-483-2461
Practice Address - Fax:173-239-5315
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional