Provider Demographics
NPI:1184072670
Name:BUTLER, ERICA LEIGH
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEIGH
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 1:213 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8131
Mailing Address - Country:US
Mailing Address - Phone:570-718-8800
Mailing Address - Fax:724-465-6379
Practice Address - Street 1:213 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SAYLORSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353-8131
Practice Address - Country:US
Practice Address - Phone:570-718-8800
Practice Address - Fax:724-465-6379
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist