Provider Demographics
NPI:1770962839
Name:BUTLER, MYESHA NICOLE
Entity type:Individual
Prefix:
First Name:MYESHA
Middle Name:NICOLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W. PACIFIC STREET
Mailing Address - Street 2:STE.2
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015
Mailing Address - Country:US
Mailing Address - Phone:702-902-2425
Mailing Address - Fax:702-823-5126
Practice Address - Street 1:16 W. PACIFIC STREET
Practice Address - Street 2:STE. 2
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-902-2425
Practice Address - Fax:702-823-5126
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health