Healthcare Provider Details

I. General information

NPI: 1376918805
Provider Name (Legal Business Name): LAKEITHIA MERCEDES BUTLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 CASS AVE STE 200
DARIEN IL
60561-5073
US

IV. Provider business mailing address

2822 W JACKSON BLVD
CHICAGO IL
60612-3653
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-7134
  • Fax:
Mailing address:
  • Phone: 773-827-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180012244
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180012244
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: