Provider Demographics
NPI:1851659882
Name:BUTTERFIELD, SAMUEL RYAN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RYAN
Last Name:BUTTERFIELD
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 1:103 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5421
Mailing Address - Country:US
Mailing Address - Phone:501-279-1191
Mailing Address - Fax:501-279-1191
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5421
Practice Address - Country:US
Practice Address - Phone:501-279-1191
Practice Address - Fax:501-279-1191
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1109081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP1109081OtherLPC