MEDICARE: MRS. AMY KITCHENS BUTLER LMFT, LPC

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	101YP2500X	Professional Counselor	13616	TX
2	106H00000X	Marriage & Family Therapist	740	LA
3	101YP2500X	Professional Counselor	2839	LA

General Provider Information

NPI Number	:	1700065216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY KITCHENS BUTLER LMFT, LPC

Provider Business Mailing Address
First Line	:	301 CANTERBURY DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3995
Country	:	US
Telephone Number	:	318-480-8182
Fax Number	:	318-383-0838

Provider Business Practice Location Address
First Line	:	5875 W 70TH ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-2629
Country	:	US
Telephone Number	:	318-480-8182
Fax Number	:	318-383-0838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	05/11/2026

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