Provider Demographics
NPI:1942742697
Name:BUTTS, MARK RICHARD (MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:BUTTS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27625 US HIGHWAY 98 BLDG A
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4816
Mailing Address - Country:US
Mailing Address - Phone:251-626-7959
Mailing Address - Fax:251-626-6122
Practice Address - Street 1:27625 US HIGHWAY 98 BLDG A
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4816
Practice Address - Country:US
Practice Address - Phone:251-626-7959
Practice Address - Fax:251-626-6122
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 1841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist