Healthcare Provider Details

I. General information

NPI: 1336868447
Provider Name (Legal Business Name): MISS KIOLGA BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 ULLOA ST
NEW ORLEANS LA
70119-6942
US

IV. Provider business mailing address

7321 BREVARD AVE
NEW ORLEANS LA
70127-1603
US

V. Phone/Fax

Practice location:
  • Phone: 504-267-5712
  • Fax: 504-267-5714
Mailing address:
  • Phone: 504-215-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18345
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18345
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: