1841401262 NPI number — MS. MICHELE KAY BUTLER-FLUTH MS, LMFT

Table of content: MS. MICHELE KAY BUTLER-FLUTH MS, LMFT (NPI 1841401262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841401262 NPI number — MS. MICHELE KAY BUTLER-FLUTH MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER-FLUTH
Provider First Name:
MICHELE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841401262
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 73RD AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLMAR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56201-8718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-905-2632
Provider Business Mailing Address Fax Number:
320-235-8059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 60TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLMAR
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56201-9140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-905-2632
Provider Business Practice Location Address Fax Number:
320-235-8059
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1177 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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