Provider Demographics
NPI:1821459348
Name:BUTLER, BRYAN LYNN (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:LYNN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E RENFRO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3941
Mailing Address - Country:US
Mailing Address - Phone:817-295-8708
Mailing Address - Fax:
Practice Address - Street 1:308 E RENFRO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3941
Practice Address - Country:US
Practice Address - Phone:817-295-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11923101YA0400X
TX71720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)