Healthcare Provider Details

I. General information

NPI: 1386559417
Provider Name (Legal Business Name): MS. CARMEN BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 FREMAUX AVE
SLIDELL LA
70458-3319
US

IV. Provider business mailing address

39426 HIGHWAY 190 E
SLIDELL LA
70461-2356
US

V. Phone/Fax

Practice location:
  • Phone: 985-771-1742
  • Fax:
Mailing address:
  • Phone: 985-290-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7995
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: