Provider Demographics
NPI:1598258824
Name:OTTER-BUGG, BLYTHE (LMSW)
Entity Type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:OTTER-BUGG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:
Other - Last Name:BUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 SOUTH SHORE DR
Mailing Address - Street 2:STE 214
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5446
Mailing Address - Country:US
Mailing Address - Phone:269-964-0153
Mailing Address - Fax:855-877-5812
Practice Address - Street 1:391 S SHORE DR STE 214
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-964-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011026061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical