Provider Demographics
NPI:1093262263
Name:BUTTERWORTH, LISA PATTERSON (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PATTERSON
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JILL
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14498 W COMISKY DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0966
Mailing Address - Country:US
Mailing Address - Phone:208-939-6667
Mailing Address - Fax:
Practice Address - Street 1:6550 W EMERALD ST STE 108
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8780
Practice Address - Country:US
Practice Address - Phone:208-342-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional