Healthcare Provider Details

I. General information

NPI: 1285496844
Provider Name (Legal Business Name): ANN M BUTCHER LMHC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5862 US HIGHWAY 11 STE 1
CANTON NY
13617-3600
US

IV. Provider business mailing address

5862 US HIGHWAY 11 STE 1
CANTON NY
13617-3600
US

V. Phone/Fax

Practice location:
  • Phone: 315-355-7834
  • Fax:
Mailing address:
  • Phone: 315-355-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: