Healthcare Provider Details

I. General information

NPI: 1699843896
Provider Name (Legal Business Name): TERESA R BUTLER LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PARK STREET
SPRINGFIELD VT
05156
US

IV. Provider business mailing address

ONE HOSPITAL COURT SUITE 410
BELLOWS FALLS VT
05101
US

V. Phone/Fax

Practice location:
  • Phone: 802-885-5171
  • Fax: 802-885-4857
Mailing address:
  • Phone: 802-463-3947
  • Fax: 802-463-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0680000285
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: