Provider Demographics
NPI:1720505902
Name:BUTCHER, ELLEN (LSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0823
Mailing Address - Country:US
Mailing Address - Phone:937-393-9662
Mailing Address - Fax:937-393-1682
Practice Address - Street 1:149 CHILLICOTHE AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1533
Practice Address - Country:US
Practice Address - Phone:993-703-9396
Practice Address - Fax:937-393-1682
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0030811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker