Provider Demographics
NPI:1740597152
Name:BUTLER, NICOLE (LMSW, LCDC-I,ASOTP,)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMSW, LCDC-I,ASOTP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W PARK ROW DR STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-2559
Mailing Address - Country:US
Mailing Address - Phone:901-213-7011
Mailing Address - Fax:
Practice Address - Street 1:600 W PARK ROW DR STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-2559
Practice Address - Country:US
Practice Address - Phone:901-213-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220041788171M00000X
TX68081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator