Provider Demographics
NPI:1013677913
Name:BUTLER, BRANDI DANIELLE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:DANIELLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 STEVENS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7574
Mailing Address - Country:US
Mailing Address - Phone:318-947-9000
Mailing Address - Fax:318-692-3904
Practice Address - Street 1:9441 STEVENS RD STE 150
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7574
Practice Address - Country:US
Practice Address - Phone:318-947-9000
Practice Address - Fax:318-692-3904
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician