Provider Demographics
NPI:1811243645
Name:BUTT, CARRIE T
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:T
Last Name:BUTT
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 1:4107 W CHEYENNE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3476
Mailing Address - Country:US
Mailing Address - Phone:702-636-9400
Mailing Address - Fax:702-478-9491
Practice Address - Street 1:4107 W CHEYENNE AVE STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3476
Practice Address - Country:US
Practice Address - Phone:702-636-9400
Practice Address - Fax:702-478-9491
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst