Individual
LORIA FAYE BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4518 CYPRESS AVE, KANSAS CITY, MO 64130-2164
(816) 912-8598
Mailing address
4518 CYPRESS AVE, KANSAS CITY, MO 64130-2164
(816) 912-8598
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
WL-1004-INIT
MO
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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