Provider Demographics
NPI:1467942417
Name:BUTTS, LAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BUTTS
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 1:223 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1316
Mailing Address - Country:US
Mailing Address - Phone:618-474-9733
Mailing Address - Fax:224-704-0530
Practice Address - Street 1:223 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1316
Practice Address - Country:US
Practice Address - Phone:618-474-9733
Practice Address - Fax:224-704-0530
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490202521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149020252OtherILLINOIS DEPARTMENT OF FINANCIAL PROFESSIONAL REGULATION