Provider Demographics
NPI:1972723484
Name:BUETTNER, KARL
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:BUETTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 S AVENUE B APT 710
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8818
Mailing Address - Country:US
Mailing Address - Phone:928-341-6045
Mailing Address - Fax:
Practice Address - Street 1:2350 S AVENUE B APT 710
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8818
Practice Address - Country:US
Practice Address - Phone:928-341-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3847545103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool