Provider Demographics
NPI:1750822144
Name:BUTNER, LYDIA (LPC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BUTNER
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 1:112 S BROADWAY AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STERLING
Mailing Address - State:KS
Mailing Address - Zip Code:67579-2133
Mailing Address - Country:US
Mailing Address - Phone:828-361-8851
Mailing Address - Fax:
Practice Address - Street 1:112 S BROADWAY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-2133
Practice Address - Country:US
Practice Address - Phone:828-361-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional