Provider Demographics
NPI:1417505314
Name:PRISCILLA C BUTLER, PSYD, LLC
Entity Type:Organization
Organization Name:PRISCILLA C BUTLER, PSYD, LLC
Other - Org Name:EUNOIA PSYCHOLOGICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-424-2128
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1622
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3668
Mailing Address - Country:US
Mailing Address - Phone:773-424-2128
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1622
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3668
Practice Address - Country:US
Practice Address - Phone:773-424-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health