Provider Demographics
NPI:1740350859
Name:BUTLER, LORRAINE ANNETTE TOLBERT (MS)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:ANNETTE TOLBERT
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ROCK SPRINGS DR APT 1081
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8326
Mailing Address - Country:US
Mailing Address - Phone:702-818-3952
Mailing Address - Fax:
Practice Address - Street 1:522 E LAKE MEAD PKWY STE 5
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5573
Practice Address - Country:US
Practice Address - Phone:702-486-6716
Practice Address - Fax:702-486-6741
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health