Provider Demographics
NPI:1205340114
Name:BUTLER, MAZIEN (BCPC)
Entity type:Individual
Prefix:
First Name:MAZIEN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45698
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4698
Mailing Address - Country:US
Mailing Address - Phone:225-924-9164
Mailing Address - Fax:225-924-5479
Practice Address - Street 1:7569 E INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-7518
Practice Address - Country:US
Practice Address - Phone:225-924-9164
Practice Address - Fax:225-924-5479
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARNLFCSVS1703101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral