Provider Demographics
NPI:1821674631
Name:BUTTS, MERCEDEZ (SAC, PS)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDEZ
Middle Name:
Last Name:BUTTS
Suffix:
Gender:F
Credentials:SAC, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511402
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-0241
Mailing Address - Country:US
Mailing Address - Phone:414-286-9055
Mailing Address - Fax:
Practice Address - Street 1:4810 S 76TH ST STE 210
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4356
Practice Address - Country:US
Practice Address - Phone:414-286-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16431-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty