Provider Demographics
NPI:1316140742
Name:BUTTON, RANDALL RUSSELL (LMSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:RUSSELL
Last Name:BUTTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CHARTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4909
Mailing Address - Country:US
Mailing Address - Phone:269-808-7443
Mailing Address - Fax:
Practice Address - Street 1:914 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1110
Practice Address - Country:US
Practice Address - Phone:269-808-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional