Provider Demographics
NPI:1508346016
Name:BUTVILAS, MONICA J (RBT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:BUTVILAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7853 RIVER RUN DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6273
Mailing Address - Country:US
Mailing Address - Phone:630-439-6468
Mailing Address - Fax:
Practice Address - Street 1:7853 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6273
Practice Address - Country:US
Practice Address - Phone:630-439-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18-63064106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician