Provider Demographics
NPI:1396217089
Name:DRAUGHN BUTLER LLC
Entity Type:Organization
Organization Name:DRAUGHN BUTLER LLC
Other - Org Name:PSYCHPROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DRAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-213-9560
Mailing Address - Street 1:4415 FLORIDA NATIONAL DR STE 209
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1571
Mailing Address - Country:US
Mailing Address - Phone:863-213-9560
Mailing Address - Fax:
Practice Address - Street 1:2033 E EDGEWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3660
Practice Address - Country:US
Practice Address - Phone:863-852-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty