Provider Demographics
NPI:1336132257
Name:BUTTS, STANLEY VERNON (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:VERNON
Last Name:BUTTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 47TH ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1251
Mailing Address - Country:US
Mailing Address - Phone:816-561-5556
Mailing Address - Fax:816-756-3151
Practice Address - Street 1:800 W 47TH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1251
Practice Address - Country:US
Practice Address - Phone:816-561-5556
Practice Address - Fax:816-756-3151
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO00020103G00000X, 103T00000X
KSKS205103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02602026OtherBCBS
KS505332OtherBCBS
KS505332OtherBCBS