Provider Demographics
NPI:1104555077
Name:BUTZKE, RACHEL ANN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:BUTZKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 N DESERT BLVD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8506
Mailing Address - Country:US
Mailing Address - Phone:915-308-0123
Mailing Address - Fax:915-234-2970
Practice Address - Street 1:6450 N DESERT BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8506
Practice Address - Country:US
Practice Address - Phone:915-308-0123
Practice Address - Fax:915-234-2970
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician