Provider Demographics
NPI:1497003016
Name:BUTCHER, THOMAS J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FLANDERS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1711
Mailing Address - Country:US
Mailing Address - Phone:860-739-8271
Mailing Address - Fax:860-887-7109
Practice Address - Street 1:315 FLANDERS RD
Practice Address - Street 2:SUITE A
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1711
Practice Address - Country:US
Practice Address - Phone:860-739-8271
Practice Address - Fax:860-887-7109
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional