Provider Demographics
NPI:1699029694
Name:BUTLER, FLOYD DENARD
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:DENARD
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 HECTORVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-4249
Mailing Address - Country:US
Mailing Address - Phone:660-202-9779
Mailing Address - Fax:
Practice Address - Street 1:10245 HECTORVILLE RD
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-4249
Practice Address - Country:US
Practice Address - Phone:660-202-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJ083438512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst