Provider Demographics
NPI:1891238168
Name:BUTLER, MAIME
Entity Type:Individual
Prefix:
First Name:MAIME
Middle Name:
Last Name:BUTLER
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 1:5700 W MICHIGAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1999
Mailing Address - Country:US
Mailing Address - Phone:269-459-1818
Mailing Address - Fax:269-365-9951
Practice Address - Street 1:5700 W MICHIGAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1999
Practice Address - Country:US
Practice Address - Phone:269-459-1818
Practice Address - Fax:269-365-9951
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health