Provider Demographics
NPI:1841346095
Name:BUTLER, MAURICE JR (BCBA)
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:BUTLER
Suffix:JR
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 NOEL MISSION DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4783
Mailing Address - Country:US
Mailing Address - Phone:901-870-2341
Mailing Address - Fax:901-755-6805
Practice Address - Street 1:4942 NOEL MISSION DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4783
Practice Address - Country:US
Practice Address - Phone:901-870-2341
Practice Address - Fax:901-755-6805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-06-2770103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities