Provider Demographics
NPI:1922381037
Name:BUTLER, THOMAS FREDERICK (MS,LCPC,CA-DC,CDOP-I)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FREDERICK
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MS,LCPC,CA-DC,CDOP-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PHELPS AVE SUITE 304
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2421
Mailing Address - Country:US
Mailing Address - Phone:815-519-6382
Mailing Address - Fax:815-708-0094
Practice Address - Street 1:129 PHELPS AVE SUITE 304
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2421
Practice Address - Country:US
Practice Address - Phone:815-519-6382
Practice Address - Fax:815-708-0094
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional