Provider Demographics
NPI:1245398742
Name:BUTLER, VIVIAN LORRAINE (LMSW,ACSW)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:LORRAINE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W MONROE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2083
Mailing Address - Country:US
Mailing Address - Phone:517-788-8330
Mailing Address - Fax:517-788-5952
Practice Address - Street 1:950 W MONROE ST STE 500
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2083
Practice Address - Country:US
Practice Address - Phone:517-788-8330
Practice Address - Fax:517-788-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008953870Medicare UPIN
MION75690Medicare ID - Type Unspecified