Provider Demographics
NPI:1679984231
Name:BUTLER, CARMEN DELORES
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:DELORES
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 N.E. 48TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111
Mailing Address - Country:US
Mailing Address - Phone:405-410-5872
Mailing Address - Fax:
Practice Address - Street 1:4337 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3001
Practice Address - Country:US
Practice Address - Phone:405-609-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor