Provider Demographics
NPI:1407034671
Name:BUTLER, GREGORY C
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:BUTLER
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 1:7170 N FINANCIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2939
Mailing Address - Country:US
Mailing Address - Phone:559-930-4206
Mailing Address - Fax:559-449-2733
Practice Address - Street 1:7170 N FINANCIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2939
Practice Address - Country:US
Practice Address - Phone:559-930-4206
Practice Address - Fax:559-449-2733
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PSY108440OtherMEDICAL
1612122Medicare UPIN