Provider Demographics
NPI:1629409354
Name:BUTLER, GEORGE (PSYD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2608
Mailing Address - Country:US
Mailing Address - Phone:954-401-3107
Mailing Address - Fax:
Practice Address - Street 1:4860 ROBB ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2184
Practice Address - Country:US
Practice Address - Phone:303-278-7418
Practice Address - Fax:888-341-5050
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSY.0003968OtherPROFESSIONAL LICENSE