Provider Demographics
NPI:1730482266
Name:BUTLER, TAMIKA (LPC)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1205
Mailing Address - Country:US
Mailing Address - Phone:314-856-5147
Mailing Address - Fax:
Practice Address - Street 1:8008 CARONDELET AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1724
Practice Address - Country:US
Practice Address - Phone:314-627-0313
Practice Address - Fax:800-335-4761
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-05
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010038945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional