Provider Demographics
NPI:1508115387
Name:BUTLER, DEBORAH MAYS (PSYCHOLOGICAL EXAMIN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MAYS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYCHOLOGICAL EXAMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ASCOT DR.
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-4203
Mailing Address - Country:US
Mailing Address - Phone:423-863-3183
Mailing Address - Fax:
Practice Address - Street 1:2 WORTH CIR
Practice Address - Street 2:SUITE #2
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4304
Practice Address - Country:US
Practice Address - Phone:423-283-4958
Practice Address - Fax:423-283-7135
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE 869101YM0800X
TN3106101YP2500X
TN541359101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool