Basic Information
Provider Information
NPI: 1437255148
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUTTREY
FirstName: TONIE
MiddleName: NONE
NamePrefix: MR.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 457 CHELAN ST
Address2:  
City: GOLDEN
State: CO
PostalCode: 804014866
CountryCode: US
TelephoneNumber: 3032787924
FaxNumber:  
Practice Location
Address1: 1055 CLERMONT ST
Address2:  
City: DENVER
State: CO
PostalCode: 802203808
CountryCode: US
TelephoneNumber: 3033998020
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X2730OKY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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