Provider Demographics
NPI:1013267939
Name:BUTLER, JERRY (D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:D
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D
Mailing Address - Street 1:4820 W RENO AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-6417
Mailing Address - Country:US
Mailing Address - Phone:803-556-4333
Mailing Address - Fax:
Practice Address - Street 1:330 W GRAY
Practice Address - Street 2:SUITE 140
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-919-6821
Practice Address - Fax:405-360-1616
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional