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General NPI Number Information
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NPI Number | 1376918805
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Entity Type | Individual
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Provider Name | LAKEITHIA MERCEDES BUTLER LCPC
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Gender | Female
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 7900 CASS AVE STE 200
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City | DARIEN
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State | IL
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Zip | 60561-5073
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Country | US
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Telephone | 630-581-7134
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Fax |
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Provider Business Mailing Address
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Address Line | 2822 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60612-3653
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Country | US
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Telephone | 773-827-1042
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180012244
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License Number State | IL
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