Provider Demographics
NPI:1336544816
Name:BUTLER, RYAN L (PAT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 GREEN RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2148
Mailing Address - Country:US
Mailing Address - Phone:307-223-6131
Mailing Address - Fax:
Practice Address - Street 1:4921 GREEN RIVER ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2148
Practice Address - Country:US
Practice Address - Phone:307-223-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPAT-068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)