Provider Demographics
NPI:1477947026
Name:BUTLER, DESDAMONA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DESDAMONA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 WESTGATE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8578
Mailing Address - Country:US
Mailing Address - Phone:629-900-9464
Mailing Address - Fax:855-420-5857
Practice Address - Street 1:1604 WESTGATE CIR STE 240
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8578
Practice Address - Country:US
Practice Address - Phone:629-900-9464
Practice Address - Fax:855-420-5857
Is Sole Proprietor?:No
Enumeration Date:2015-03-21
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14291101YP1600X
LCCT0443010515101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral