Provider Demographics
NPI:1639148430
Name:BUTLER, JODY L (LCSW)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5847
Mailing Address - Country:US
Mailing Address - Phone:865-386-4642
Mailing Address - Fax:865-379-2869
Practice Address - Street 1:307 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5847
Practice Address - Country:US
Practice Address - Phone:865-386-4642
Practice Address - Fax:865-379-2869
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000268101YA0400X
TNLSW00000045991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNLDC0000000268OtherSTATE LICENSE
TNLSW0000004599OtherSTATE LICENSE