Healthcare Provider Details

I. General information

NPI: 1023487956
Provider Name (Legal Business Name): MOLLIE G BUTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLIE GRACE GEREN LMSW

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29437 HWY 63 STE. 14
LIVINGSTON LA
70754
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-283-1356
  • Fax: 225-283-1705
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12637
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number12637
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: