Provider Demographics
NPI:1871292391
Name:BUTTS, BROOKE ALEXIS
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXIS
Last Name:BUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 BIRCHWOOD PIKE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-7913
Mailing Address - Country:US
Mailing Address - Phone:304-270-7279
Mailing Address - Fax:
Practice Address - Street 1:12504 BIRCHWOOD PIKE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:TN
Practice Address - Zip Code:37341-7913
Practice Address - Country:US
Practice Address - Phone:304-270-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst