Provider Demographics
NPI:1518780204
Name:BUTLER, BEUNKA (CADC, CHW, DUI)
Entity type:Individual
Prefix:
First Name:BEUNKA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CADC, CHW, DUI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 E 50TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2597
Mailing Address - Country:US
Mailing Address - Phone:773-629-7477
Mailing Address - Fax:
Practice Address - Street 1:613 E 50TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2597
Practice Address - Country:US
Practice Address - Phone:773-629-7477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X, 174200000X
IL37312101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174200000XOther Service ProvidersMeals