Provider Demographics
NPI:1497455604
Name:BUTLER, CAREY
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASU DR # 523
Mailing Address - Street 2:
Mailing Address - City:LORMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39096-7500
Mailing Address - Country:US
Mailing Address - Phone:601-618-5017
Mailing Address - Fax:
Practice Address - Street 1:805 N BEECH ST # 2
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-3809
Practice Address - Country:US
Practice Address - Phone:318-493-5147
Practice Address - Fax:318-493-5147
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor