Provider Demographics
NPI:1588015390
Name:BUTLER, PEARL (LPC, MS)
Entity type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45710
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-5710
Mailing Address - Country:US
Mailing Address - Phone:267-551-1852
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 45710
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-5710
Practice Address - Country:US
Practice Address - Phone:267-551-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health