Provider Demographics
NPI:1295209542
Name:BUTLER, DONYELLE ALEAH
Entity Type:Individual
Prefix:
First Name:DONYELLE
Middle Name:ALEAH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W AIRLINE HWY STE V
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3817
Mailing Address - Country:US
Mailing Address - Phone:859-618-3403
Mailing Address - Fax:985-618-3404
Practice Address - Street 1:429 W AIRLINE HWY STE V
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3817
Practice Address - Country:US
Practice Address - Phone:985-618-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010963236106S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician