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General NPI Number Information
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NPI Number | 1609261049
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Entity Type | Individual
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Provider Name | LAUREN GRACE HANSEN BUTLER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 8570 GRANITE CT STE 101
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City | FORT MYERS
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State | FL
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Zip | 33908-4240
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Country | US
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Telephone | 352-483-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 SHENANDOAH CT
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City | MARCO ISLAND
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State | FL
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Zip | 34145-5024
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Country | US
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Telephone | 630-664-5516
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043121A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY11758
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License Number State | FL
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