Provider Demographics
NPI:1568752442
Name:BUTLER, LISA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E SHOWALTER ST
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-9765
Mailing Address - Country:US
Mailing Address - Phone:316-303-5952
Mailing Address - Fax:
Practice Address - Street 1:437 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2413
Practice Address - Country:US
Practice Address - Phone:316-264-8344
Practice Address - Fax:316-263-5259
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist