Provider Demographics
NPI:1548877467
Name:BUTLER, CLAY B
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 E WASHINGTON ST STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2661
Mailing Address - Country:US
Mailing Address - Phone:317-622-2467
Mailing Address - Fax:
Practice Address - Street 1:10609 E WASHINGTON ST STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2661
Practice Address - Country:US
Practice Address - Phone:317-319-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health