Provider Demographics
NPI:1013460435
Name:MICHAEL BUTKUS PHD LP PLLC
Entity type:Organization
Organization Name:MICHAEL BUTKUS PHD LP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-219-6363
Mailing Address - Street 1:43200 DEQUINDRE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1707
Mailing Address - Country:US
Mailing Address - Phone:586-799-4350
Mailing Address - Fax:586-799-4279
Practice Address - Street 1:43200 DEQUINDRE RD STE 104
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1707
Practice Address - Country:US
Practice Address - Phone:586-799-4350
Practice Address - Fax:586-799-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty