Provider Demographics
NPI:1184697575
Name:BUTCHER, RONALD WILLIAM (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WILLIAM
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RON
Other - Middle Name:WILLIAM
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:2020 WEST PINHOOK ROAD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-593-0830
Mailing Address - Fax:337-593-0122
Practice Address - Street 1:2020 WEST PINHOOK ROAD
Practice Address - Street 2:SUITE 504
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:337-593-0122
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1823104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5849Medicaid