Provider Demographics
NPI:1497152557
Name:BUTLER, ROYCE DUANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:DUANE
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 ANSELMO LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1101
Mailing Address - Country:US
Mailing Address - Phone:225-768-6401
Mailing Address - Fax:
Practice Address - Street 1:7850 ANSELMO LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1101
Practice Address - Country:US
Practice Address - Phone:225-768-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2274103TH0004X
LA1308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical