Provider Demographics
NPI:1669703096
Name:HAYNES BUTLER, LAWANA KAY (BS)
Entity type:Individual
Prefix:MS
First Name:LAWANA
Middle Name:KAY
Last Name:HAYNES BUTLER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6930 S HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:WAUKOMIS
Mailing Address - State:OK
Mailing Address - Zip Code:73773-1304
Mailing Address - Country:US
Mailing Address - Phone:580-395-0455
Mailing Address - Fax:
Practice Address - Street 1:1625 W GARRIOTT RD
Practice Address - Street 2:SUITE F
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5653
Practice Address - Country:US
Practice Address - Phone:580-242-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health