Provider Demographics
NPI:1922831486
Name:BUTT, MICHAELAN MERCEDES (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAELAN
Middle Name:MERCEDES
Last Name:BUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MERCEDES
Other - Last Name:BUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1713 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7100
Mailing Address - Country:US
Mailing Address - Phone:812-258-0310
Mailing Address - Fax:
Practice Address - Street 1:1713 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7100
Practice Address - Country:US
Practice Address - Phone:812-258-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011346A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical