Provider Demographics
NPI:1457189250
Name:BUTCHER, TAMMY M (MA)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:M
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880-9551
Mailing Address - Country:US
Mailing Address - Phone:304-887-7408
Mailing Address - Fax:
Practice Address - Street 1:251 VISTA DR
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-9551
Practice Address - Country:US
Practice Address - Phone:304-887-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical