Provider Demographics
NPI:1841401262
Name:BUTLER-FLUTH, MICHELE KAY (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:KAY
Last Name:BUTLER-FLUTH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 73RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-8718
Mailing Address - Country:US
Mailing Address - Phone:320-905-2632
Mailing Address - Fax:320-235-8059
Practice Address - Street 1:2120 60TH AVE NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-9140
Practice Address - Country:US
Practice Address - Phone:320-905-2632
Practice Address - Fax:320-235-8059
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist