Provider Demographics
NPI:1548389356
Name:BUTTRAM, JOHN E (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:BUTTRAM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 E WASHINGTON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3974
Mailing Address - Country:US
Mailing Address - Phone:406-257-5400
Mailing Address - Fax:406-755-7733
Practice Address - Street 1:38 E WASHINGTON ST STE 4
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3974
Practice Address - Country:US
Practice Address - Phone:406-257-5400
Practice Address - Fax:406-755-7733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0251108Medicaid