Provider Demographics
NPI:1821382318
Name:BUTCHER, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:BUTCHER
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 1:66 NORTH 180 WEST
Mailing Address - Street 2:
Mailing Address - City:EPHRIAM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1111
Mailing Address - Country:US
Mailing Address - Phone:435-283-0164
Mailing Address - Fax:435-283-2213
Practice Address - Street 1:66 NORTH 180 WEST
Practice Address - Street 2:
Practice Address - City:EPHRIAM
Practice Address - State:UT
Practice Address - Zip Code:84627-1111
Practice Address - Country:US
Practice Address - Phone:435-283-0164
Practice Address - Fax:435-283-2213
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children