Provider Demographics
NPI:1376739946
Name:BUTLER, CYNTHIA SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SUE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424
Mailing Address - Country:US
Mailing Address - Phone:660-425-6151
Mailing Address - Fax:660-425-6191
Practice Address - Street 1:4118 MILLER ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424
Practice Address - Country:US
Practice Address - Phone:660-425-6151
Practice Address - Fax:660-425-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070286071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical