Provider Demographics
NPI:1700407830
Name:BUTLER, MARY ANNETTE (RN, PHD, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNETTE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 109TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7341
Mailing Address - Country:US
Mailing Address - Phone:806-705-1305
Mailing Address - Fax:
Practice Address - Street 1:301 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2746
Practice Address - Country:US
Practice Address - Phone:806-743-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252620363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health