Provider Demographics
NPI:1922076553
Name:BUTZMAN, CAROL (LPCMH CCDCIII QMHP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BUTZMAN
Suffix:
Gender:F
Credentials:LPCMH CCDCIII QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 5TH STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6026
Mailing Address - Country:US
Mailing Address - Phone:605-418-4004
Mailing Address - Fax:605-418-4002
Practice Address - Street 1:4940 5TH STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6026
Practice Address - Country:US
Practice Address - Phone:605-418-4004
Practice Address - Fax:605-418-4002
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCCDCIII101YA0400X
SDICADC14768101YA0400X
SDLPCMH2009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575060Medicaid
SD23145OtherSIOUX VALLEY
SDNP4273OtherDAKOTACARE
SD23145OtherAVERA
SD4998865OtherBCBS