Provider Demographics
NPI:1295383404
Name:BUTCHER, VINCENT BERNARD SR (MS, MRE, LPC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:BERNARD
Last Name:BUTCHER
Suffix:SR
Gender:M
Credentials:MS, MRE, LPC
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 792
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0792
Mailing Address - Country:US
Mailing Address - Phone:318-283-8887
Mailing Address - Fax:
Practice Address - Street 1:420 WHEELIS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-3940
Practice Address - Country:US
Practice Address - Phone:318-556-8455
Practice Address - Fax:318-556-8456
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2024-05-28
Deactivation Date:2019-09-02
Deactivation Code:
Reactivation Date:2019-11-04
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X
LA8095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional