MEDICARE: SHANTELE BUTLER COUNSELING & TELETHERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1184292708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANTELE BUTLER COUNSELING & TELETHERAPY

Provider Business Mailing Address
First Line	:	1234 DEL ESTE AVE STE 402
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4829
Country	:	US
Telephone Number	:	225-380-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 DEL ESTE AVE STE 402
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4829
Country	:	US
Telephone Number	:	225-380-9151
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ OPERATOR
Name	:	MRS. SHANTELE ANGELA BUTLER
Credential	:	LPC
Telephone Number	:	225-380-5191

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	07/20/2021

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