Provider Demographics
NPI:1700065216
Name:BUTLER, AMY KITCHENS (LMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KITCHENS
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5559
Mailing Address - Country:US
Mailing Address - Phone:318-480-8182
Mailing Address - Fax:318-383-0838
Practice Address - Street 1:5875 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2629
Practice Address - Country:US
Practice Address - Phone:318-480-8182
Practice Address - Fax:318-383-0838
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2839101YP2500X
LA740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional