Provider Demographics
NPI:1255841763
Name:BUTSCH, TRAVIS DEAN
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:DEAN
Last Name:BUTSCH
Suffix:
Gender:M
Credentials:
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 47877
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-7877
Mailing Address - Country:US
Mailing Address - Phone:360-236-4700
Mailing Address - Fax:
Practice Address - Street 1:10710 MUKILTEO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5021
Practice Address - Country:US
Practice Address - Phone:425-349-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health