Healthcare Provider Details

I. General information

NPI: 1982929477
Provider Name (Legal Business Name): KAREN BUTLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N MAIN ST
RANDOLPH VT
05060-1126
US

IV. Provider business mailing address

PO BOX G
RANDOLPH VT
05060-0167
US

V. Phone/Fax

Practice location:
  • Phone: 802-728-4466
  • Fax: 802-728-4197
Mailing address:
  • Phone: 802-728-4466
  • Fax: 802-728-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100.0057961
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: