Provider Demographics
NPI:1972733723
Name:BUTLER, EBONI TIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EBONI
Middle Name:TIANA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:EBONI
Other - Middle Name:TIANA
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4031 FOREST TEAL CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8648
Mailing Address - Country:US
Mailing Address - Phone:281-431-5323
Mailing Address - Fax:281-431-5324
Practice Address - Street 1:4031 FOREST TEAL CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8648
Practice Address - Country:US
Practice Address - Phone:281-431-5323
Practice Address - Fax:281-431-5324
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62492101YP2500X
TX34589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional