Provider Demographics
NPI:1023342136
Name:BUTZON, COLBY DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:DOUGLAS
Last Name:BUTZON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:COLBY
Other - Middle Name:B
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3876 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2512
Practice Address - Country:US
Practice Address - Phone:901-377-2711
Practice Address - Fax:901-382-9051
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2905103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I680978OtherMEDICARE PTAN
TN1516308Medicaid