Provider Demographics
NPI:1043306723
Name:BUTTERBAUGH, GRANT JACKSON JR (PHD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:JACKSON
Last Name:BUTTERBAUGH
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-309-9855
Mailing Address - Fax:504-814-4346
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-309-9855
Practice Address - Fax:504-814-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-10-02
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Provider Licenses
StateLicense IDTaxonomies
LA681103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical