Provider Demographics
NPI:1831500990
Name:BUTLER, LAURA SHAW (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SHAW
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8544
Mailing Address - Country:US
Mailing Address - Phone:817-626-6401
Mailing Address - Fax:817-626-6400
Practice Address - Street 1:111 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8544
Practice Address - Country:US
Practice Address - Phone:817-626-6401
Practice Address - Fax:817-626-6400
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical