Provider Demographics
NPI:1396232443
Name:BUTLER, AVALON TOPAZ I
Entity Type:Individual
Prefix:MRS
First Name:AVALON
Middle Name:TOPAZ
Last Name:BUTLER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 BAYBERRY LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-3626
Mailing Address - Country:US
Mailing Address - Phone:386-947-7817
Mailing Address - Fax:
Practice Address - Street 1:4497 POWDERHORN PLACE DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8929
Practice Address - Country:US
Practice Address - Phone:877-312-3552
Practice Address - Fax:407-308-0490
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty