Provider Demographics
NPI:1437720133
Name:BUTLER, ANTHONY MARTIN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARTIN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45415 LAMPLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:OTTERTAIL
Mailing Address - State:MN
Mailing Address - Zip Code:56571-9500
Mailing Address - Country:US
Mailing Address - Phone:646-249-5031
Mailing Address - Fax:
Practice Address - Street 1:2864 MIDDLE ST STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1411
Practice Address - Country:US
Practice Address - Phone:651-493-2055
Practice Address - Fax:651-340-8632
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND60721041C0700X
MN297021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical