Provider Demographics
NPI:1265457428
Name:BUTLER, TIMOTHY (LAC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LAKE PENCHANT CT
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8324
Mailing Address - Country:US
Mailing Address - Phone:985-872-6769
Mailing Address - Fax:
Practice Address - Street 1:205 LAKE PENCHANT CT
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8324
Practice Address - Country:US
Practice Address - Phone:985-872-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)