Provider Demographics
NPI:1447328182
Name:BUTLER, GILBERT WAYNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:WAYNE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 E ERVIN RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2521
Mailing Address - Country:US
Mailing Address - Phone:419-238-1430
Mailing Address - Fax:419-238-5571
Practice Address - Street 1:15145 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9619
Practice Address - Country:US
Practice Address - Phone:888-241-1780
Practice Address - Fax:419-238-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0933379Medicaid
OH000000116037OtherANTHEM
OHBUCP03744Medicare ID - Type Unspecified