Provider Demographics
NPI:1376950196
Name:BUTLER, BENNIE W (LAC, LPC)
Entity Type:Individual
Prefix:
First Name:BENNIE
Middle Name:W
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ARDMORE ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8804
Mailing Address - Country:US
Mailing Address - Phone:720-621-5944
Mailing Address - Fax:720-222-5109
Practice Address - Street 1:12835 EAST ARAPAHOE
Practice Address - Street 2:TOWER2, STE:440
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:720-621-5944
Practice Address - Fax:720-222-5109
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000467101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33704210Medicaid