Provider Demographics
NPI:1184292708
Name:SHANTELE BUTLER COUNSELING & TELETHERAPY
Entity type:Organization
Organization Name:SHANTELE BUTLER COUNSELING & TELETHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTELE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:225-380-5191
Mailing Address - Street 1:1234 DEL ESTE AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4829
Mailing Address - Country:US
Mailing Address - Phone:225-380-5191
Mailing Address - Fax:
Practice Address - Street 1:1234 DEL ESTE AVE STE 402
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4829
Practice Address - Country:US
Practice Address - Phone:225-380-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty