Provider Demographics
NPI:1588430052
Name:BUTLER, TONY (LCSW)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:372 SOUTHERN ASTER TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7038
Mailing Address - Country:US
Mailing Address - Phone:859-408-5523
Mailing Address - Fax:
Practice Address - Street 1:372 SOUTHERN ASTER TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7038
Practice Address - Country:US
Practice Address - Phone:859-408-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37671041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker