Provider Demographics
NPI:1942074240
Name:BUTLER, BROOKE (LMFT-A)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT-A
Mailing Address - Street 1:8112 AUSBLICK AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4592
Mailing Address - Country:US
Mailing Address - Phone:682-561-9126
Mailing Address - Fax:
Practice Address - Street 1:3400 KERBEY LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1455
Practice Address - Country:US
Practice Address - Phone:682-231-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist