Provider Demographics
NPI:1568508984
Name:BUTKINS, PETER ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:BUTKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 DOUGLAS AVE
Mailing Address - Street 2:STE 2155 27 DR PETER A BUTKINS
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-774-1452
Mailing Address - Fax:407-774-1452
Practice Address - Street 1:455 DOUGLAS AVE
Practice Address - Street 2:STE 2155 27 DR PETER A BUTKINS
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-774-1452
Practice Address - Fax:407-774-1452
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist