Provider Demographics
NPI:1164902102
Name:BUTZE, MELODIE JANELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:JANELLE
Last Name:BUTZE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6555
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-1083
Mailing Address - Country:US
Mailing Address - Phone:770-536-9903
Mailing Address - Fax:770-536-9904
Practice Address - Street 1:1745 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1717
Practice Address - Country:US
Practice Address - Phone:770-536-9903
Practice Address - Fax:770-536-9904
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional