Provider Demographics
NPI:1629373584
Name:BUTLER-MOORE, LINDA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:BUTLER-MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-742-3408
Mailing Address - Fax:318-841-1210
Practice Address - Street 1:1301 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-5117
Practice Address - Country:US
Practice Address - Phone:318-675-0804
Practice Address - Fax:318-425-9030
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional