Healthcare Provider Details

I. General information

NPI: 1033588892
Provider Name (Legal Business Name): SHANTELE ANGELA BUTLER LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 JACKSON ST
CLINTON LA
70722-3210
US

IV. Provider business mailing address

30826 LINDER RD
DENHAM SPRINGS LA
70726-8507
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax: 225-683-3411
Mailing address:
  • Phone: 225-665-7878
  • Fax: 225-665-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3525
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: