Provider Demographics
NPI:1356576615
Name:BUTLER, THOMAS WILLIAM (MDIV)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 ONTARIO ST APT 3BN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1924
Mailing Address - Country:US
Mailing Address - Phone:708-383-4223
Mailing Address - Fax:
Practice Address - Street 1:1033 ONTARIO ST APT 3BN
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1924
Practice Address - Country:US
Practice Address - Phone:708-383-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health