=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962877464
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER BUTTS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2015
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1585 BATTLE RIDGE RD
-----------------------------------------------------
City | KOOSKIA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83539-5092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-553-8137
-----------------------------------------------------
Fax | 208-298-3851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1585 BATTLE RIDGE RD
-----------------------------------------------------
City | KOOSKIA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83539-5092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-553-8137
-----------------------------------------------------
Fax | 208-298-3851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LCSW-39493
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-39493
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | BBH-LCSW-LIC-70670
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------