Provider Demographics
NPI:1891857827
Name:BUTLER-DUBE, LYNN ANN (LCMHC, LADC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:BUTLER-DUBE
Suffix:
Gender:F
Credentials:LCMHC, LADC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SHELBURNE RD
Mailing Address - Street 2:PIERSON HOUSE D2
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7700
Mailing Address - Country:US
Mailing Address - Phone:802-859-1577
Mailing Address - Fax:802-859-1571
Practice Address - Street 1:1233 SHELBURNE RD
Practice Address - Street 2:PIERSON HOUSE D2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7700
Practice Address - Country:US
Practice Address - Phone:802-859-1577
Practice Address - Fax:802-859-1571
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000034101YA0400X
VT068-0000470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010021Medicaid