Provider Demographics
NPI:1336918077
Name:BUTLER, TELEETHA (ALC)
Entity Type:Individual
Prefix:
First Name:TELEETHA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1552
Mailing Address - Country:US
Mailing Address - Phone:334-655-8117
Mailing Address - Fax:
Practice Address - Street 1:5565 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1552
Practice Address - Country:US
Practice Address - Phone:334-655-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health