Provider Demographics
NPI:1902208580
Name:BUTLER, EBONY OTEARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EBONY
Middle Name:OTEARA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1902
Mailing Address - Country:US
Mailing Address - Phone:601-559-7886
Mailing Address - Fax:
Practice Address - Street 1:5008 BONNEVILLE BND
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-5431
Practice Address - Country:US
Practice Address - Phone:601-559-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37606103T00000X
CA26557103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist