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General NPI Number Information
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NPI Number | 1154119329
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Entity Type | Individual
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Provider Name | SHANDRA RAE BUTLER M.ED. LDT, CALT
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2419 BINZ ST
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City | HOUSTON
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State | TX
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Zip | 77004-7503
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Country | US
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Telephone | 713-397-3525
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 BINZ ST
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City | HOUSTON
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State | TX
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Zip | 77004-7503
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Country | US
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Telephone | 713-397-3525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 3118
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3118
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 3118
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 3118
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License Number State | TX
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