Provider Demographics
NPI:1487143137
Name:BUTLER, MELISSA (LLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 WHITEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5364
Mailing Address - Country:US
Mailing Address - Phone:734-904-7699
Mailing Address - Fax:
Practice Address - Street 1:120 E LIBERTY ST STE 215
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2156
Practice Address - Country:US
Practice Address - Phone:734-904-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015183103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling