Provider Demographics
NPI:1962881532
Name:PATRICIA BUTLER-MATTHEWS
Entity type:Organization
Organization Name:PATRICIA BUTLER-MATTHEWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:BUTLER-MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-656-8855
Mailing Address - Street 1:18120 SNOWDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1471
Mailing Address - Country:US
Mailing Address - Phone:313-656-8855
Mailing Address - Fax:
Practice Address - Street 1:18120 SNOWDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1471
Practice Address - Country:US
Practice Address - Phone:313-656-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health