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NPI Code Detail

MEDICARE: DR. LAUREN GRACE HANSEN BUTLER PSY.D.

MEDICARE: DR. LAUREN GRACE HANSEN BUTLER PSY.D.
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
1101YM0800XMental Health Counselor
2103TC0700XClinical Psychologist20043121AIN
3103TC0700XClinical PsychologistPY11758FL

General Provider Information

NPI Number : 1609261049
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAUREN GRACE HANSEN BUTLER PSY.D.
Provider Business Mailing Address
First Line : 1214 SHENANDOAH CT
Second Line :
City : MARCO ISLAND
State : FL
Zip : 34145-5024
Country : US
Telephone Number : 630-664-5516
Fax Number :
Provider Business Practice Location Address
First Line : 8570 GRANITE CT STE 101
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-4240
Country : US
Telephone Number : 352-483-3769
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2015
Last Update Date : 03/29/2023

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