=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376950196
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENNIE W BUTLER LAC, LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2014
-----------------------------------------------------
Last Update Date | 07/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12835 EAST ARAPAHOE TOWER2, STE:440
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-621-5944
-----------------------------------------------------
Fax | 720-222-5109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 ARDMORE ST
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80104-8804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-621-5944
-----------------------------------------------------
Fax | 720-222-5109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | ACD.0000467
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------