Healthcare Provider Details

I. General information

NPI: 1184292708
Provider Name (Legal Business Name): SHANTELE BUTLER COUNSELING & TELETHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 DEL ESTE AVE STE 402
DENHAM SPRINGS LA
70726-4829
US

IV. Provider business mailing address

1234 DEL ESTE AVE STE 402
DENHAM SPRINGS LA
70726-4829
US

V. Phone/Fax

Practice location:
  • Phone: 225-380-9151
  • Fax:
Mailing address:
  • Phone: 225-380-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANTELE ANGELA BUTLER
Title or Position: OWNER/ OPERATOR
Credential: LPC
Phone: 225-380-5191