Provider Demographics
NPI:1558459636
Name:BUTLER, DAVID JOSEPH SR (LISAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:BUTLER
Suffix:SR
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4341 S HIGHWAY 92
Mailing Address - Street 2:SUITE F
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9399
Mailing Address - Country:US
Mailing Address - Phone:520-803-7500
Mailing Address - Fax:520-803-7512
Practice Address - Street 1:4341 S HIGHWAY 92
Practice Address - Street 2:SUITE F
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9399
Practice Address - Country:US
Practice Address - Phone:520-803-7500
Practice Address - Fax:520-803-7512
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ911512OtherCHS
AZ911512OtherAHCCCS
AZAZ0420540OtherBCBS