Provider Demographics
NPI:1275091118
Name:BUTLER, CAMERON (LPC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 UNGER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BELLVUE
Mailing Address - State:CO
Mailing Address - Zip Code:80512-6066
Mailing Address - Country:US
Mailing Address - Phone:970-682-5294
Mailing Address - Fax:
Practice Address - Street 1:144 N MASON ST UNIT 6
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-7103
Practice Address - Country:US
Practice Address - Phone:970-439-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional