Provider Demographics
NPI:1003000506
Name:BUTLER, KEISHA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 400-8
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4312
Mailing Address - Country:US
Mailing Address - Phone:214-298-7647
Mailing Address - Fax:469-227-4251
Practice Address - Street 1:100 N CENTRAL EXPY
Practice Address - Street 2:SUITE 400-8
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4312
Practice Address - Country:US
Practice Address - Phone:214-298-7647
Practice Address - Fax:469-227-4251
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional