Individual
JOCELYN J BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
6335 CONSTITUTION DR, FORT WAYNE, IN 46804-1547
(260) 436-5353
(260) 436-5399
Mailing address
6335 CONSTITUTION DR, FORT WAYNE, IN 46804-1547
(260) 436-5353
(260) 436-5399
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000879
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000374537
ANTHEM PROVIDER NUMBER
IN
01
—
028606
VALUE OPTIONS PROVIDER
IN
01
—
059800000
MAGELLAN PROVIDER NUMBER
IN
01
—
090721
MANAGED HEALTH NETWORK
IN
Enumeration date
09/20/2006
Last updated
07/22/2016
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