Provider Demographics
NPI:1467080416
Name:BUTNER, TRAVIS S (LPC, CSAC)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:S
Last Name:BUTNER
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5557
Mailing Address - Country:US
Mailing Address - Phone:540-905-9752
Mailing Address - Fax:
Practice Address - Street 1:316 BROOK PARK PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2766
Practice Address - Country:US
Practice Address - Phone:434-533-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional