Provider Demographics
NPI:1891034120
Name:BUTCHER, SHIRLEY RAE (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:RAE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE N-385
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3489
Mailing Address - Country:US
Mailing Address - Phone:612-326-7571
Mailing Address - Fax:651-647-9147
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE N-385
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3489
Practice Address - Country:US
Practice Address - Phone:612-326-7571
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303272101YA0400X
MNCC01420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)