Provider Demographics
NPI:1700533072
Name:BUTLER, MALCOLM (LMSW)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:PENNS GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-2546
Mailing Address - Country:US
Mailing Address - Phone:856-275-5568
Mailing Address - Fax:
Practice Address - Street 1:6955 S UNION PARK CTR STE 400
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-4192
Practice Address - Country:US
Practice Address - Phone:856-275-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD27779101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health